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目的探讨多药耐药基因(MDR1)外显子21(exon21)的基因多态性对肾移植术后患者免疫抑制剂应用的影响。方法选择同种异体肾移植术后患者168例。采用聚合酶链反应(PCR)扩增MDR1基因,限制性内切片段多态性(RFLP)方法对MDR1基因进行分型。根据分型将患者分为GG、GT和TT3组,对肾移植术后第1、3、6、12个月中每月每2组患者间的CsA浓度与每天每公斤体重的CsA剂量比值进行比较。结果168例患者中GG型46例(27.4%),GT型76例(45.2%),TT型46例(27.4%)。GG型患者CsA浓度剂量比值明显低于GT型和TT型患者,差异均有统计学意义(P<0.01),而GT型患者CsA浓度剂量比值又低于TT型患者,差异有统计学意义(P<0.05)。结论同种异体肾移植患者MDR1exon21基因型和CsA血药浓度与每天每公斤体重CsA剂量的比值有明显关系。GG型患者的比值明显低于GT或TT型患者,GG型患者达到相似的血药浓度需服用更高剂量的CsA。
Objective To investigate the effect of gene polymorphism of multidrug resistance gene (MDR1) exon21 on the use of immunosuppressants in patients after kidney transplantation. Methods 168 cases of allograft recipients were selected. The MDR1 gene was amplified by polymerase chain reaction (PCR) and the restriction endonuclease fragment polymorphism (RFLP) method was used to genotype the MDR1 gene. According to the classification, the patients were divided into GG, GT and TT3 groups. The ratio of CsA concentration to CsA dose per kilogram of body weight per 2 groups of patients per month in the 1st, 3rd, 6th and 12th month after renal transplantation Compare Results Of the 168 patients, 46 (27.4%) had GG, 76 (45.2%) had GT, and 46 (27.4%) had TT. The CsA concentration to dose ratio in patients with GG was significantly lower than those in patients with GT and TT (P <0.01), while those with GT were lower than those with TT (P <0.01). The difference was statistically significant P <0.05). Conclusions The ratio of MDR1exon21 genotype and CsA plasma concentration to daily CsA dose per kilogram of body weight in allograft recipients has a significant relationship. GG patients were significantly lower than the GT or TT type of patients, GG patients to achieve similar plasma concentrations need to take higher doses of CsA.