分析肾移植受者围手术期霉酚酸(MPA)血药浓度监测结果和不良反应发生情况，以促进临床合理用药。

回顾性分析2022年10月1日至11月31日浙江大学医学院附属第一医院肾移植围手术期受者临床资料。52例受者均于肾移植术后第2天开始监测MPA血药浓度谷值(C₀)，其中29例于肾移植术后第4天监测MPA血药浓度-时间曲线下面积(AUC)。通过医院信息系统收集其年龄、性别、MPA-C₀和MPA-AUC监测结果、白细胞水平以及腹泻和排斥反应发生情况等信息。两组间比较采用独立样本t检验，P<0.05为差异具有统计学意义。

52例肾移植受者术后监测MPA-C₀平均为(4.1±2.3)mg/L，其中1.0～3.5 mg/L 24例(46.15%)，>3.5 mg/L 28例(53.85%)。29例受者MPA-AUC平均为(54±23)mg·h^－1·L^－1，其中30～60 mg·h^－1·L^－1 14例(48.28%)，<30 mg·h^－1·L^－1 5例(17.24%)，>60 mg·h^－1·L^－1 10例(34.48%)。女性受者(n＝9)MPA-AUC高于男性(n＝20)，分别为(68±16)和(48±23)mg·h^－1·L^－1，差异有统计学意义(t＝－2.31，P<0.05)。29例监测MPA-AUC肾移植受者中19例使用吗替麦考酚酯(MMF)，10例使用麦考酚钠肠溶片(EC-MPS)，MMF和EC-MPS AUC分别为(53±26)和(57±15)mg·h^－1·L^－1，差异无统计学意义(t＝0.46，P>0.05)。52例肾移植受者围手术期均未发生排斥反应。1例(1.92%)受者于肾移植术后第21天发生粒细胞减少。6例(11.54%)受者发生腹泻，在减少MPA剂量和使用蒙脱石散对症处理后症状缓解。

肾移植受者围手术期MPA暴露量差异较大，近半数受者MPA暴露量不符合指南要求。MPA不良反应发生率相对较低，较高的MPA暴露量与受者不良反应无关。

This study aimed to analyze the mycophenolic acid (MPA) blood concentration in patients during the perioperative period after kidney transplantation and to observe the adverse reactions to MPA to promote rational clinical medication.

The clinical data of perioperative recipients after kidney transplantation at the First Affiliated Hospital of Zhejiang University School of Medicine from October 1 to November 31, 2022 were retrospectively analyzed. MPA- concentration of 0 h (C₀) were monitored in fifty-two recipients beginning on the second day after the operation. The MPA-area under curve (AUC) was monitored for 29 recipients on the fourth day after the operation. Patient information about age, sex, MPA-C₀, MPA-AUC, white blood cell levels, incidence of diarrhea and rejection was collected through the hospital information system. Independent sample t-test was used for comparisons between two groups, and P<0.05 indicated a statistically significant difference.

The average MPA-C₀ in 52 kidney transplant recipients was (4.1±2.3) mg/L, with 24 (46.15%) ranging from 1.0 to 3.5 mg/L and 28 (53.85%) exceeding 3.5 mg/L. The average MPA-AUC of 29 recipients was (54±23) mg·h^-1·L^-1, including 14 patients (48.28%) receiving 30-60 mg·h^-1·L^-1, 5 patients (17.24%) receiving less than 30 mg·h^-1·L^-1, and 10 patients (34.48%) receiving more than 60 mg·h^-1·L^-1. The MPA-AUC of female recipients (n=9) was higher than that of male recipients (n=20), with values of (68±16) and (48±23) mg·h^-1·L^-1, respectively (t=-2.31, P<0.05). Among the 29 recipients for whom the MPA-AUC was monitored, 19 used mycophenolate mofetil (MMF), and 10 used enteric-coated mycophenolate sodium (EC-MPS). The AUC of MMF and EC-MPS were (53±26) and (57±15) mg·h^-1·L^-1, respectively, with no statistically significant difference (t=0.46, P >0.05). None of the recipients experienced any rejection reactions during the perioperative period. One (1.92%) of the recipients experienced granulocytopenia on the 21st day after kidney transplantation. Six (11.54%) of the recipients experienced diarrhea, and symptoms improved after reducing the dosage of MPA and symptomatic treatment with montmorillonite powder.

There was a significant difference in MPA exposure levels among recipients during the perioperative period after kidney transplantation, with nearly half of the recipients not meeting the guidelines. The incidence of adverse reactions to MPA was relatively low, and higher exposure to MPA was not related to adverse reactions in recipients.