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目的系统评价CYP3A5基因型与肾移植术后他克莫司(FK506)血药浓度的关系。方法计算机检索PubMed(1966.1~2013.7)、Scivers(e1823.1~2013.7)、he Cochrane Librar(y2013年第7期)、CNK(I1994.1~2013.7)、VIP(1989.1-2013.7)、CBM(1978.1~2013.7)及WanFang Data(1995.1~2013.7),查找关于CYP3A5基因型与肾移植术后他克莫司(FK506)血药浓度/剂量关系的文献。根据纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入12篇文献,包含956例对象。Meta分析结果显示:在肾移植术后7天[MD=54.61,95%CI(–67.67,–41.54),P<0.000 01]、1个月[MD=–74.84,95%CI(–83.39,–66.29),P<0.000 01]、3个月[MD=–96.09,95%CI(–107.55,–84.64),P<0.000 01]、6个月[MD=–107.30,95%CI(–125.65,–88.95),P<0.000 01]和1年[MD=–78.32,95%CI(–123.02,–33.61),P=0.000 6],携带CYP3A5*3/*3基因型患者的FK506血药浓度/剂量值明显较携带其他基因型患者高;而携带*1/*1患者的FK506血药浓度/剂量值较低。结论肾移植术后FK506血药浓度/剂量值与CYP3A5基因型相关。因此在肾移植术后应用FK506作为免疫抑制治疗时,有必要对患者进行CYP3A5基因型检测,以指导临床治疗。
Objective To systematically evaluate the relationship between CYP3A5 genotype and plasma concentration of tacrolimus (FK506) after renal transplantation. Methods We searched PubMed (1966.1 ~ 2013.7), Scivers (e1823.1 ~ 2013.7), he Cochrane Librar (y2013), CNK (I1994.1 ~ 2013.7), VIP (1989.1-2013.7), CBM 2013.7) and WanFang Data (1995.1 ~ 2013.7) to find out the relationship between the CYP3A5 genotype and the plasma concentration / dose of tacrolimus (FK506) after renal transplantation. After screening and documenting the inclusion and exclusion criteria, extracting data and evaluating quality, Meta-analysis was performed using RevMan 5.2 software. Results A total of 12 articles were included, including 956 subjects. Meta-analysis showed that on the 7th day after kidney transplantation [MD = -54.61,95% CI (-67.67, -41.54), P <0.000 01], one month [MD = -74.84,95% CI (-83.39, -66.29), P <0.000 01], 3 months [MD = -96.09,95% CI (-107.55, -84.64), P <0.000 01], 6 months [MD = -107.30, 95% CI P <0.000 01] and 1 year [MD = -78.32,95% CI (-123.02, -33.61), P = 0.0006], FK506 blood in patients with CYP3A5 * 3 / * 3 genotype Drug concentration / dose values were significantly higher in patients with other genotypes than in those with * 1 / * 1 patients. Conclusion The plasma concentration / dose of FK506 after renal transplantation is related to the CYP3A5 genotype. Therefore, the application of FK506 after renal transplantation as immunosuppressive therapy, it is necessary for patients with CYP3A5 genotype testing to guide clinical treatment.