接受硫唑嘌呤治疗的克罗恩患者的红细胞6-TGN水平和血液学参数

作     者：D'Halluin P. -N. Tribut O. Branger B. D. Heresbach. 王晓君(译) 史敏(校) 

作者机构：不详 Service des Maladies de I'Appareil Digestif (SMAD) Hopital Pontchaillou rue Henri Le Guilloux35033 Rennes Cedex 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第6期

页      面：28-29页

学科分类：1008[医学-中药学(可授医学、理学学位)] 1006[医学-中西医结合] 1011[医学-护理学（可授医学、理学学位）] 100602[医学-中西医结合临床] 10[医学] 

主　　题：血液学参数 成年患者 硫唑嘌呤 红细胞 治疗 RBC计数 6-巯基嘌呤 高效液相色谱法 中性粒细胞计数 

摘      要：Objective-The immunosuppressive properties of azathioprine (AZA) are mediated by intracellular metabolism of 6-MP into its active metabolites 6-thiguanine nucleotide (6-TGN) and 6-methylmercaptopurine (6-MMP). The aims of this study were to correlate red blood cell (RBC) 6-TGN and hematological parameters and their change in adult patients with Crohn’s disease (CD) treated by AZA and to determine independent factors enabling determination of RBC 6-TGN. Methods-RBC 6-TGN concentration was determined with high performance liquid chromography (HLPC) performed on 74 heparinized blood samples from 32 patients. Changes of hematological parameters were measured for each RBC 6-TGN concentration. RBC 6-TGN concentration above 235 pmol/8×108 RBC was proposed as the therapeutic level in patients treated by AZA. Correlations between the various parameters were assessed as appropriate. Logistic regression analysis was used to determinate independent variables. P 0.05 was considered significant. Results-There was a positive correlation between RBC 6-TGN and decreased red cell count (ΔRBC) (r = 0.314; P = 0.006), platelet count (ΔPlatelets) (r = 0.314; P = 0.007), White cell count (ΔWC) (r = 0.241; P = 0.04) and neutrophil count (ΔPMN) (r = 0.292; P = 0.02). RBC 6-TGN in the therapeutic zone was positively correlated with mean corpuscular volume (MCV) (r = 0.527; P = 0.01), mean corpuscular hemoglobin concentration (MCHC) (r = 0.437; P = 0.04), increase in MCV (ΔMCV) (r = 0.512; P = 0.012), decrease in White cell count (ΔWC) (r = 0451; P = 003) and in neutrophil count (ΔPMN) (r = 0.463; P = 0.03). Multivariate analysis showed that low activity of CD (P 0.02), young age at onset of treatment by AZA (P 0.03) and a low red cell distribution width (RDW) (P = 0.003) were independent factors for RBC 6-TGN situated in therapeutic zone. RBC 6-TGN could be determined by logistic regression from AZA dose (mg/kg/d) and MCV increase. Conclusion-This study confirms that hematological par