联苯双酯对肾移植患者环孢素血药浓度的影响

目的 观察肾移植术后环孢素(CaA)与联苯双酯滴丸(BFD)合用时对CsA血药浓度的影响.方法 肾移植术后(30±15)d,肝损伤患者40例,常规使用CaA 麦考酚吗乙酯(MMF) 泼尼松(Pred)抗排斥.当患者出现肝功能受损时开始服用BFD,首剂量为45 mg·d-1.待肝功能正常后,BFD进行梯度减药(由45 mg·d-1减至4.5 mg·d-1),减药间隔时间为15 d.BFD用药期间,CaA用量(6.5±1.0)ms·kg-1·d-1不变.肾移植患者在保肝治疗前,每次更改BFD用药方案前及停BFD 15 d后测定CsA血药浓度,并行尿常规及肝、肾功能检测.结果 40例肾移植患者保肝治疗前CsA血药浓度为(312.6±13)μg·L-1,服BFD首次剂量15 d后,CsA药浓度降至(158.3±14)μg·L-1;经1～4次递减BFD后,CsA血药浓度分别为(161.2±13)、(188.1±16)、(204.1±15)、(221.7±11)μg·L-1;停服BFD 15 d后CsA血药浓度为(258.4±13)μg·L-1.总胆红素(TB)由(30±5.0)μmol·L-1降至(17±3.0)μmol·L-1,丙氨酸氨基转移酶(ALT)由(100±50)U·L-1降至(30±10)U·L-1,尿量、尿常规、肾功能无明显变化.结论 CsA与BFD合用,可导致CsA血药浓度下降.临床用药需注意监测,及时调整用药剂量,避免浓度过低,导致严重的移植肾排斥.     

联苯双酯对环孢素A经大鼠小肠给药药动学影响的研究

目的:阐明联苯双酯(bifendate,BFD)对环孢素A(cyclosporin,CsA)经大鼠小肠给药药动学的影响。方法:两组大鼠分别给予0.5%CMC-Na和BFD(20mg.kg-1)连续灌胃6d,第7天分别从十二指肠幽门端注入CsA(1mg.kg-1)或CsA(1mg.kg-1) BFD(20mg.kg-1),从门静脉采血,用荧光偏振免疫法测定全血CsA浓度。结果:与单用CsA组相比,联用BFD组的Cmax平均降低55.7%(P<0.01),AUC平均降低49.7%(P<0.01)。联用BFD组的t1/2β、CL/F、V/F与单用CsA组相比明显升高(P<0.01或0.05)。其余参数在两组间差异无显著性(P>0.05)。结论:BFD可明显降低CsA的生物利用度,肠道可能是此相互作用发生的部位之一。     

联苯双酯滴丸影响环孢素A血药浓度2例

患者 1,男 ,4 2岁。患者因尿毒症行同种异体尸肾移植手术 ,术后服用环孢素A、霉酚酸酯、泼尼松等抗排异。术后前85d的给药方案为环孢素A 170mgbid、泼尼松 15mgqd、1.0 gbid、合心爽 30mgtid、百令胶囊 1.0 gtid、肝泰乐 0 .2 gtid、联苯双酯滴丸 15mgtid等 ,监测环孢素A血药浓度为2 90 .37μg·L-1。第 86天起停用联苯双酯滴丸 ,其他用药同上。 10d后即术后 96d监测环孢素A血药浓度为5 13.0 6 μg·L-1。结果停用联苯双酯滴丸 10d后 ,环孢素A血药浓度增加到 2 2 2 .6 9μg·L-1(5 13.0 6～ 2 90 .37μg·L-1)。采血时间均因定在早上服…     

联苯双酯对狗体内环孢素A的药动学影响

目的:考察联苯双酯(DDB)与环孢素A(CsA)在比格犬(beagle dog)体内合用后联苯双酯对CsA动力学过程的影响。方法:采用安慰剂、随机交叉试验方法。用放射免疫分析法测定6只比格犬单用CsA及合用DDB后CsA的血药浓度,并进行动力学参数的计算与比较。结果:CsA与DDB合用后,CsA在比格犬体内的血药浓度普遍降低,相对清除率(CL/F)显著增大[(1.1±0.8)mL.h-1.kg-1,(1.9±1.4)mL.h-1.kg-1,P<0.05],生物半衰期(t1/2)显著缩短[(14.3±3.4)h,(10.3±2.5)h,P<0.05],AUC明显变小[(11.1±4.1)mg.L-1.h,(7.4±3.7)mg.L-1.h,P<0.05],其余的参数无统计学差异(P>0.05)。结论:DDB可明显降低CsA的血药浓度。临床上合用DDB和CsA时必须监测CsA的血药浓度,随时调整给药剂量,保证安全有效的治疗。     

黄连素或联苯双酯及其与环孢素合用对小鼠小肠运动的影响

目的:研究黄连素(berberine,Ber)或联苯双酯(bifendate,BFD)分别与环孢素(Cyclosporin A,CsA)合用对小鼠小肠运动的影响。方法:采用小鼠炭末推进法研究药物对小鼠小肠运动的影响。结果:与溶媒(CMCⅠ)组比较,Ber(300 mg·kg~(-1))组和Ber CsA(300 mg·kg~(-1) 20 mg·kg~(-1))组炭末推进率显著减少(P<0.01,P<0.05);与CsA(20 mg·kg~(-1))组比较,Ber CsA(200 mg·kg~(-1) 20 mg·kg~(-1))组和Ber CsA(300 mg·kg~(-1) 20 mg·kg~(-1))组炭末推进率显著减少(P<0.01)。与溶媒(CMCⅡ)组比较,CsA(10 mg·kg~(-1))组和BFD(100 mg·kg~(-1))组炭末推进率显著增加(P<0.05);与CsA(10 mg·kg~(-1))组比较,BFD(100 mg·kg~(-1))组炭末推进率有显著增加(P<0.05),而BFD CsA(100 mg·kg~(-1) 10 mg·kg~(-1))组推进率没有显著差异。结论:Ber单用及其与CsA合用,对小鼠的小肠运动有极显著的抑制作用,BFD单用有显著促进小鼠小肠运动的作用,而BFD与CsA合用,未显示对小鼠的小肠运动有影响。     

环孢素A与盐酸小檗碱合用对大鼠肝脏和小肠药物代谢酶的影响

目的:研究盐酸小檗碱(berberine chloride,Ber)与环孢素A(CsA)合用对大鼠肝脏和小肠药物代谢酶的影响.方法:采用分光光度法测定各给药组大鼠肝脏和小肠微粒体中红霉素N-脱甲基酶(ERD)、氨基比林N-脱甲基酶(ADM)和谷胱甘肽转移酶(GST)的活性.结果:Ber组和Ber CsA组能明显抑制肝微粒体中ERD、ADM和GST酶活性(P< 0.05 ),而且Ber CsA组较CsA单用组有更明显的抑制作用(P< 0.05 ).Ber CsA组还能明显抑制肠微粒体中ERD、ADM和GST酶活性(P< 0.05 ).结论:Ber与CsA合用时,能显著抑制大鼠肝脏和小肠药物代谢酶活性,这可能是Ber增加CsA血药浓度的一个重要机制.     

联苯双酯对肾移植受者环孢素A全血浓度的影响及肝毒性的防护作用

目的 :研究肾移植受者应用联苯双酯 (bifen date ,BFD)对环孢素A(cyclosporinA ,CsA)全血浓度的影响及肝毒性的防护作用。方法 :2 8例患者 (合用组 )合用CsA与BFD ,30例患者 (对照组 )单服CsA ,以CsA全血浓度及肝功能作为临床评价指标。结果 :BFD能有效降低肾移植受者异常升高的ALT和AST ,合用BFD后CsA全血浓度与合用前比较降幅达 17.7% ,与对照组比较亦有显著性降低 (P <0 .0 1) ,停用BFD后CsA全血浓度明显升高 ,增幅达36 .3%。结论 :BFD能防护肾移植受者CsA肝毒性并能明显降低CsA血浓度。     

联苯双酯对兔体内环孢素A药代动力学影响的实验及临床观察

目的:考察联苯双酯(BFD)与环孢素A(CsA)在兔体内并用后,对CsA动力学过程的影响.方法:用高效液相色谱法测定6只兔在单用CsA和并用BFD后CsA的血药浓度,并进行动力学参数的计算与比较.结果:CsA与BFD并用后,CsA在兔体内的血浓度普遍降低,表观分布容积及清除率显著增大(0.05＞P＞0.01),AUC明显小于单用CsA(0.05＞P＞0.01)时的AUC,其余的参数无统计学差异.通过临床观察,验证了肾移植患者在同时服用CsA和BFD后造成体内CsA全血药物浓度降低,与兔实验结果一致.结论:BFD可明显降低CsA的血药浓度,不宜与CsA联用.     

联苯双酯对家兔体内环孢菌素A的药动学影响

目的 :考察联苯双酯 (BFD)与环孢菌素A(CsA)在兔体内合用后联苯双酯对环孢菌素A动力学过程的影响。方法 :用高效液相色谱法测定 6只家兔单用环孢菌素A及合用联苯双酯后环孢菌素A的血药浓度并进行动力学参数的计算与比较。结果 :CsA与BFD合用后 ,CsA在家兔体内的血药浓度普遍降低 ,表观分布容积及清除率显著增大 (P <0 .0 5 ) ,AUC明显小于单用CsA(P <0 .0 5 ,P >0 .0 1)时的AUC ,其余的参数无统计学差异。结论 :BFD可明显降低CsA的血药浓度。     

联苯双酯对大鼠黄曲霉毒素B1代谢及肝毒性的影响

目的研究抗肝炎药联苯双酯对大鼠黄曲霉毒素B1代谢和肝毒性的影响.方法大鼠po联苯双酯300 mg*kg-1*d-1, 连服3 d后ip黄曲霉毒素B1 1.5 mg*kg-1.给黄曲霉毒素B1 16 h后测定血清ALT和AST水平,观察联苯双酯对黄曲霉毒素B1引起肝损伤的保护作用以及对体外代谢的影响.结果联苯双酯(300 mg*kg-1*d-1,连服3 d)可明显降低黄曲霉毒素B1引起的大鼠血清转氨酶升高,增加低毒代谢产物AFM1的生成.联苯双酯还可增加大鼠肝脏细胞色素P450总量和胞浆GSH含量,诱导P450 2B1介导的PROD和GST的活性.此外,联苯双酯对P450 3A介导的红霉素脱甲基酶和P450 1A介导的EROD也有一定的诱导作用.结论联苯双酯可通过增加大鼠肝脏对AFB1代谢的解毒功能起到肝保护作用.     

反相高效液相色谱法测定联苯双酯及其滴丸的含量

目的建立测定联苯双酯及滴丸含量的反相高效液相色谱法。方法采用德国M erck公司L iChroCART C18柱(250mm×4mm,5μm)为色谱柱,流动相为甲醇-水(65∶35),流速为1.0mL.m in-1,检测波长278nm,柱温35℃。结果联苯双酯在6.04~60.4μg.mL-1浓度范围内线性关系良好(r=0.9999)。原药平均加样回收率为99.5%(RSD=0.53%,n=9),滴丸平均加样回收率为98.7%(RSD=0.85%,n=9)。结论本法用于测定联苯双酯及其滴丸含量,简便、快速,测定结果准确。     

Comparative Effects of Fibrates on Drug Metabolizing Enzymes in Human Hepatocytes

No HeadingPurpose. The induction potential of different fibric acid derivatives on human drug metabolizing enzymes was evaluated to help assess the role of enzyme induction on pharmacokinetic drug interactions.Methods. Effects of gemfibrozil, fenofibric acid, and clofibric acid on expression levels of cytochromes P450 (CYPs) 3A4 and 2C8 and UDP-glucuronyltransferase (UGT) 1A1 were evaluated in primary human hepatocyte cultures. The potential for these fibrates to activate human pregnane X receptor (PXR) also was studied in a cell-based PXR reporter gene assay.Results. All three fibrates caused increases in mRNA levels of CYP3A4 (2- to 5-fold), CYP2C8 (2- to 6-fold), and UGT1A1 (2- to 3-fold). On average, the effects on CYP3A4 were less than (30% of rifampin), while those on CYP2C8 and UGT1A1 were comparable to or slightly higher than (up to 200% of rifampin) the corresponding effects observed with rifampin (10 M). Consistent with the mRNA results, all fibrates caused moderate (<2- to 3-fold) increases in CYP3A4 activity (measured by testosterone 6 hydroxylase), as compared to about a 10-fold increase by rifampin. Significant increases (3- to 6-fold) in amodiaquine N-deethylase (a functional probe for CYP2C8 activity) also were observed with clofibric acid, fenofibric acid, and rifampin, in agreement with the mRNA finding. However, in contrast to the mRNA induction, marked decreases (>60%) in CYP2C8 activity were obtained with gemfibrozil treatment. Consistent with this finding, co-incubation of amodiaquine with gemfibrozil, but not with fenofibric acid, clofibric acid, or rifampin, in human liver microsomes or hepatocytes resulted in significantly decreased amodiaquine N-deethylase activity (IC₅₀ = 80 M for gemfibrozil, >500 M for fenofibric or clofibric acid, and >50 M for rifampin). Similar to rifampin, all three fibrates caused a modest change in the glucuronidation of chrysin, a nonspecific substrate of UGTs. No significant activation on human pregnane X receptor (PXR) was observed with the three fibrates in a PXR reporter gene assay.Conclusions. In human hepatocytes, both fenofibric acid and clofibric acid are inducers of CYP3A4 and CYP2C8. Gemfibrozil is also an inducer of CYP3A4, but acts as both an inducer and an inhibitor of CYP2C8. In this system, all fibrates are weak inducers of UGT1A1. The enzyme inducing effects of fibrates appear to be mediated via a mechanism(s) other than PXR activation. These results suggest that fibrates may have potential to cause various pharmacokinetic drug interactions via their differential effects on enzyme induction and/or inhibition.     

Induction of Rat Hepatic Microsomal Drug Metabolizing Enzymes by Pyrazole and 4-Substituted Pyrazoles

Pyrazole and 4-methylpyrazole are potent inhibitors of liver alcohol dehydrogenase and as such have been proposed as potential antidotes to alcohol poisoning. These drugs are also inducers of hepatic cytochrome P-450. We tested pyrazole and four 4-substituted pyrazoles for their potential as inducers of cytochrome P-450 and drug metabolism in mature male rats. Total cytochrome P-450 was significantly increased (p < 0.05) 1.3 fold by treatment with 4-methylpyrazole. P-nitrophenol hydroxylase (PNPH) activity (nmol/min/mg protein) was increased 1.9 fold following treatment with pyrazole and with 4-methylpyrazole. Treatment with 4-methyl-pyrazole also resulted in a 2.9 fold increase in ethoxyresorufin deethylase (EROD) activity. In addition, pyrazole treatment led to a significant decrease in the activity of benzphetamine demethylase. 4-lodopyrazole increased the turnover (nmol/min/nmol P-450) of EROD and PNPH by 1.5 fold each. 4-Nitropyrazole had no significant effect on any of the activities or turnover rates tested. In contrast to results with cultured chick hepatocytes, where induction was directly related to teh hydrophobicity of the 4-substituent, the present data indicate that the process of induction in vivo is more complex.     

Effects of Phenoxyacetic Acid Herbicides on Chicken Embryo Liver Drug Metabolizing Enzymes

Abstract: Chick embryos were treated on day 0 of incubation with two phenoxy herbicides, 2-methyl-4-chlorophenoxyacetic acid (MCPA) (0.4, 2 mg/egg) and 2,4-dichlorophenoxyacetic acid (2, 4-D) (1, 2, 4 mg/egg). Both herbicides seemed to exert toxic effects mainly on the liver of 19-day-old embryos. Specific histological analysis indicated biliary stasis. Ethoxycoumarin O-deethylase was depressed by MCPA but raised by 2, 4-D. Other hepatic monooxygenase activities were unaffected by the herbicides and no significant changes were found in cytochromes. The higher dose of MCPA increased NADPH-cytocrome P₄₅₀ reductase. 2,4-D treatment increased by activity of glutathione-S-transferases in the hepatic post-microsomal fraction while MCPA increased them at the lower dose and significantly reduced them at the higher. The phenoxyacetic herbicides appear thus to have some effects on hepatic drug metabolizing enzymes of the chick embryo which cannot be easily interpreted. Biliary retention, produced in particular by MCPA, could be partly responsible for these effects.     

羟氯喹在人肝微粒体CYP酶中的代谢研究

目的：探讨羟氯喹在人肝微粒体中的主要代谢酶及其代谢特点和参数。方法：建立高效液相色谱-荧光检测器（HPLC-FLD）测定孵育液中羟氯喹的方法,观察9种CYP酶特异性抑制剂对羟氯喹代谢的影响,计算羟氯喹的酶促动力学参数如米氏常数（Km）、最大反应速度（Vmax）和药物的内在清除率（CLint）。结果：9种酶抑制剂中孟鲁司特（CYP2CB抑制剂）、酮康唑（CYP3A4抑制剂）、噻氯匹定（CYP2B6抑制剂）能够显著抑制羟氯喹的代谢（P ＜ 0.05）。羟氯喹在人肝微粒体中Vmax为233.6 ng·mL-1·h-1·mgprotein-1,Km为14.5 ng·mL-1,CLint为16.2 h-1·mgprotein-1。结论：羟氯喹主要通过CYP2C8、CYP3A4和CYP2B6代谢,药物在体内清除速率慢,药物相互作用和蓄积是发生不良反应的重要因素。     

佩尔地平缓释剂对肾移植病人环孢霉素A代谢的影响

目的：研究8名肾移植并发高血压症患者,接受药物环孢霉素A（CsA)和新型钙通道阻滞剂佩尔地平（perdipine)缓释胶囊治疗,方法：在肾移植术后第3周开始口服佩尔地平,同时监测病人CsA血药浓度、血清肌酐值。结果：8名病人中7名CsA血药浓度、血清肌酐值显著升高,停用佩尔地平后,CsA血药浓度、血清肌酐值恢复到原有水平。结论：提示佩尔地平影响CsA的代谢,在停药后,此拮抗作用可逆转。因此,肾移植病人服用钙通道阻滞剂应注意监测CsA血药浓度。     

环孢素A用于银屑病治疗的血药浓度监测追溯分析

目的:评价环孢素A(cyclosporine A,CsA)血药浓度监测对临床银屑病治疗的有效监护作用.方法:收集2018—2020年中国医学科学院皮肤病医院161例采用CsA治疗的银屑病住院患者的资料,对性别、年龄、剂量、联合用药等与CsA血药浓度的相关影响进行比较分析.结果:161例患者共监测CsA血药浓度288例次...     

五酯胶囊对环孢素在大鼠小肠吸收的影响

目的：研究五酯胶囊（WuZhi—capsule，WZ）对环孢素（cyclosporinA，CsA）在大鼠小肠吸收的影响。方法：三组大鼠分别以CsA试液、含WZ100mg&#183;L^-1的CsA试液、含WZ200mg&#183;L^-1的CsA试液进行在体肠段吸收实验，HPLC法测定CsA浓度。结果：与单用CsA相比，回肠段合用WZ组CsA吸收率明显降低，空肠段合用WZ组CsA吸收无明显变化。结论：WZ对CsA小肠吸收有抑制作用。     

代谢酶和转运体介导的草药-化学药相互作用安全性研究进展

目的 分析药物代谢酶和转运体介导的草药-化学药相互作用(herb-drug interactions,HDIs)和不良反应发生机制,总结常用草药与化学药物之间潜在相互作用的信息.方法 通过PubMed、Web of Science和中国知网等文献检索数据库,对草药、转运体、代谢酶等关键词进行文献检索.结果 草药与化学药...     

复方丹参片对环孢素A肾毒性的拮抗作用研究

目的:探讨复方丹参对环孢素A(CsA)所致慢性肾毒性的拮抗作用。方法:对54例肾移植手术的患者进行分析,根据应用复方丹参的剂量不同,将其分为3组:CsA+复方丹参高剂量组、CsA+复方丹参低剂量组(试验组)、CsA对照组(对照组)。监测3组的CsA血药浓度、血肌酐、尿素氮浓度、24h尿量、24h尿蛋白量以及比较组织形态学及血流参数,并对各组间的差异进行统计学分析。结果:应用CsA+复方丹参高剂量组方案的患者与应用其他方案的患者相比血肌酐、尿素氮浓度、24h尿蛋白量明显降低,24h尿量增加,3组比较均有显著性差异(P<0.01或P<0.05);CsA血药浓度3组比较差异无统计学意义(P>0.05)。肾内血流丰富,肾动脉阻力指数明显增加。结论:应用CsA+复方丹参高剂量组方案能更好的拮抗CsA的肾毒性。