他克莫司与其它药物相互作用致肾移植受者高钾血症10例临床分析

邱春燕; 隋雨荧; 于立新; 邓文锋; 苗芸; 刘如敏; 叶桂荣

doi:10.3969/j.issn.1674-7445.2017.01.008

他克莫司与其它药物相互作用致肾移植受者高钾血症10例临床分析

doi: 10.3969/j.issn.1674-7445.2017.01.008

510515 广州，南方医科大学临床医学八年制（邱春燕、隋雨荧）；南方医科大学南方医院器官移植科（于立新、邓文锋、苗芸、刘如敏、叶桂荣）

基金项目:

国家自然科学基金 81500573

南方医科大学南方医院院长基金 2013B011

南方医科大学南方医院院级教育课题 14NJ-ZL01

详细信息

通讯作者:
苗芸，Email：miaoyunecho@126.com

中图分类号: R617, R619+.4
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- 被引次数: 0
出版历程
- 收稿日期: 2016-09-20
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-01-15

Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal transplant recipients

Eight-year MD-PhD Program, Southern Medical University, Guangzhou 510515, China

More Information

Corresponding author: Miao Yun, E-mail:miaoyunecho@126.com

摘要

摘要: 目的探讨肾移植术后用药导致他克莫司(FK506) 血药浓度过高引起高钾血症的处理方法。方法对肾移植术后服用抗真菌药物致FK506血药浓度过高而引起的高钾血症10例患者的临床资料进行归纳和分析。结果 10例患者术后1~2个月内出现肺部感染或肺炎合并肺部真菌感染等，对症选用相应剂量的复方磺胺甲唑、米卡芬净、头孢哌酮钠-舒巴坦钠和莫西沙星等药物进行抗真菌感染治疗。经过降钾治疗及停用抗真菌药物、调整FK506剂量（部分病例更换为环孢素）后，10例患者血钾下降并维持在正常范围，同时FK506血药浓度也在正常范围，之后未采取任何降血钾措施，未再发生高血钾现象。结论肾移植术后用药易导致FK506血药浓度过高，引起高钾血症，治疗上应采用降钾、停用相关药物、调整免疫抑制剂，避免产生有害的相互作用。
- 他克莫司 /
- 相互作用 /
- 高钾血症 /
- 术后，肾移植 /
- 临床研究
Abstract: Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifungal medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infection or pneumonia complicated with pulmonary fungal infection. An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotassemia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.
- Tacrolimus /
- Interaction /
- Hyperpotassemia /
- Postoperative, Renal transplantation /
- Clinical trial

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表 1 10例肾移植术后高钾血症患者的临床情况

Table 1. Clinical data of the 10 patients with hyperkalemia after renal transplantation

序号	性别	年龄 (岁)	抗真菌药物	治疗方法	血钾浓度（mmol/L）		FK506血药浓度（ng/mL）		预后和转归
序号	性别	年龄 (岁)	抗真菌药物	治疗方法	治疗前	纠正高钾血症期间	治疗前	纠正高钾血症期间	预后和转归
1	女	32	米卡芬净	常规降钾	5.32	4.9	15.1	7.0	治愈
2	女	35	伏立康唑	常规降钾	5.31	5.0	15.3	14.5	治愈
3	男	48	米卡芬净、伊曲康唑	常规降钾；CsA代替FK506	6.71	5.1	21.5	13.4	治愈
4	男	40	米卡芬净	常规降钾	5.30	4.7	16.0	9.2	治愈
5	男	33	伊曲康唑	常规降钾	5.42	4.5	19.0	12.2	治愈
6	男	41	米卡芬净	常规降钾；CsA代替FK506	5.65	4.5	19.7	10.3	治愈
7	男	41	卡泊芬净、伊曲康唑	常规降钾	5.61	4.4	17.6	7.1	治愈
8	男	35	卡泊芬净、伏立康唑	常规降钾	5.86	4.9	18.1	12.8	治愈
9	男	50	米卡芬净、伊曲康唑	常规降钾	5.33	4.5	16.8	7.7	治愈
10	男	61	米卡芬净、伊曲康唑	常规降钾；CsA代替FK506	5.57	4.7	18.3	9.2	治愈
本院血钾浓度正常参考值为3.50~5.30 mmol/L

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参考文献(17)

[1]	韩锐, 贾立华, 刘泽源, 等.几种常见免疫抑制剂的研究进展[J].中国药业, 2011, 20(13):1-4. DOI: 10.3969/j.issn.1006-4931.2011.13.001. Han R, Jia LH, Liu ZY, et al. Progresses in research of some common immunosuppressant drugs[J]. Chin Pharm, 2011, 20(13):1-4. DOI: 10.3969/j.issn. 1006-4931.2011.13.001.
[2]	Barbarino JM, Staatz CE, Venkataramanan R, et al. Pharmgkb summary cyclosporine and tacrolimus pathways [J]. Pharmacogenet Genomics, 2013, 23(10):563-585. DOI: 10.1097/FPC.0b013e328364db84.
[3]	尚丫茹, 潘晓鸣, 薛武军, 等.肾移植术后他克莫司致高钾血症1例[J].北方药学, 2016, 13(3):186. http://www.cnki.com.cn/Article/CJFDTOTAL-BFYX201603144.htm Shang YR, Pan XM, Xue WJ, et al. High potassium induced by tacrolimus after renal transplantation: a report of one case[J]. J North Pharm, 2016, 13(3):186. http://www.cnki.com.cn/Article/CJFDTOTAL-BFYX201603144.htm
[4]	孙雨平, 史国兵, 樊蓉, 等.他克莫司致不良反应67例文献分析[J].医药导报, 2014, (11):1535-1537.DOI: 10.3870/yydb.2014.11.039. Sun YP, Shi GB, Fan R, et al. Literature analysis of 67 cases with adverse drug reactions induced by tacrolimus[J]. Herald Med, 2014, (11):1535-1537. DOI: 10.3870/yydb.2014.11.039.
[5]	杨梦, 左笑丛, 汪江林, 等.他克莫司药效学研究进展[J].中国临床药理学与治疗学, 2014, 19(1):90-95. http://www.cnki.com.cn/Article/CJFDTOTAL-YLZL201401019.htm Yang M, Zuo XC, Wang JL, et al. Advance in study on tacrolimus pharmacodynamics[J]. Chin J Clin Pharmacol Therap, 2014, 19(1):90-95. http://www.cnki.com.cn/Article/CJFDTOTAL-YLZL201401019.htm
[6]	Shihab FS, Lee ST, Smith LD, et al. Effect of corticosteroid withdrawal on tacrolimus and mycophenolate mofetil exposure in a randomized multicenter study[J]. Am J Transplant, 2013, 13(2):474-484. DOI: 10.1111/j.1600-6143.2012.04327.x.
[7]	Albring A, Wendt L, Harz N, et al. Relationship between pharmacokinetics and pharmacodynamics of calcineurin inhibitors in renal transplant patients[J]. Clin Transplant, 2015, 29(4):294-300. DOI: 10.1111/ctr.12504.
[8]	王志宏, 刘蕾.他克莫司的药物相互作用研究进展[J].临床合理用药杂志, 2010, 13(4):430-434. DOI: 10.3969/j.issn.1007-9572.2010.04.034. Wang ZH, Liu L. Advance in study on interactions of tacrolimus with other drugs[J]. Chin J Clin Ration Drug Use, 2010, 13(4):430-434. DOI: 10.3969/j.issn.1007-9572.2010.04.034.
[9]	张咏赞, 张翠欣.他克莫司药理作用及临床疗效的研究进展[J].中国医院药学杂志, 2016, 36(3):241-244.DOI: 10.13286/j.cnki.chinhosppharmacyj.2016.03.20. Zhang YC, Zhang CX. Research progress of pharmacological effects and clinical efficacy of tacrolimus[J]. Chin J Hosp Pharm, 2016, 36(3):241-244. DOI: 10.13286/j.cnki.chinhosppharmacyj.2016.03.20.
[10]	中华医学会器官移植分会, 中国医师协会器官移植医师分会.中国器官移植受者血脂管理指南(2016版) [J].器官移植, 2016, 7(4):243-254. DOI: 10.3969/j.issn.1674-7445.2016.04.001. Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Guideline on hypertension management of recipients with organ transplantation in China (2016 edition)[J]. Organ Transplant, 2016, 7(4):243-254. DOI: 10.3969/j.issn.1674-7445.2016.04.001.
[11]	马葵芬, 陈泉金, 许小鑫, 等.肾移植术后肺部感染的药学监护重点[J].药品评价, 2016, 13(10):33-35, 64. http://www.cnki.com.cn/Article/CJFDTOTAL-YPPJ201610007.htm Ma KF, Chen QJ, Xu XX, et al. Pharmaceutical care of pulmonary infection after renal transplantation[J]. Drug Evaluat, 2016, 13(10):33-35, 64. http://www.cnki.com.cn/Article/CJFDTOTAL-YPPJ201610007.htm
[12]	李明亚.临床药物治疗学[M].北京:中国医药科技出版社, 2015.
[13]	Sivakumar V, Sriramnaveen P, Krishna C, et al. Role of fludrocortisone in the management of tacrolimus-induced hyperkalemia in a renal transplant recipient[J]. Saudi J Kidney Dis Transpl, 2014, 25(1):149-151. doi: 10.4103/1319-2442.124539
[14]	Pavleska-Kuzmanovska S, Popov Z, Ivanovski O, et al. Cyclosporine nephrotoxicity and early posttransplant hyperkalemia in living-donor renal recipients: report of 4 cases[J]. Exp Clin Transplant, 2014, 12(5):479-483. DOI: 10.6002/ect.2013.0159.
[15]	Hartono C, Muthukumar T, Suthanthiran M. Immunosuppressive drug therapy[J]. Cold Spring Harb Perspect Med, 2013, 3(9): a015487. DOI: 10.1101/cshperspect.a015487.
[16]	Mangray M, Vella JP. Hypertension after kidney transplant[J]. Am J Kidney Dis, 2011, 57(2):331-341. DOI: 10.1053/j.ajkd.2010.10.048.
[17]	任晓蕾, 詹轶秋, 张春燕, 等. 66例药源性高钾血症文献分析[J].中国药房, 2015, 26(20):2790-2792.DOI: 10.6039/j.issn.1001-0408.2015.20.18. Ren XL, Zhan YQ, Zhang CY, et al. Literature analysis of 66 cases of drug-induced hyperkalemia[J]. Chin Pharma, 2015, 26(20):2790-2792. DOI: 10.6039/j.issn.1001-0408.2015.20.18.