The Association of Tacrolimus Formulation on Cerebral Blood Flow and Cognitive Function.
The Association of Tacrolimus Formulation on Cerebral Blood Flow and Cognitive Function.
复制标题
DOI：
10.1097/txd.0000000000001511
复制
发表时间：
2023-08
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
--
作者：
钙调磷酸酶抑制剂是固有的血管收缩剂。脑血管收缩可减少脑血流量（CBF），并对运动的脑血管反应（CVR）和认知功能产生负面影响。每日一次缓释（LCP）他克莫司比速释（IR）他克莫司副作用更少。钙调磷酸酶抑制剂对CBF的作用以及他克莫司特定制剂对CBF、CVR和认知功能的影响尚不清楚。在这项初步研究中，我们评估了从IR他克莫司到LCP他克莫司的改变是否会调节肾移植（KT）受者的CBF、CVR或认知功能。我们将30名接受IR他克莫司的稳定KT受者随机（2：1）分为干预组（改用LCP他克莫司）和对照组（继续IR他克莫司）。我们在基线和12周时测量了CBF、CVR和认知功能。我们使用ANCOVA评估结果变量的变化，基线值和研究组作为协变量。我们使用描述性统计量和结果变量的平均变化来比较两组。参与者年龄为51 ± 13岁。两组基线和12周时他克莫司血浆水平无差异。干预组的CBF、静息大脑中动脉血流速度、CVR和认知功能的变化均优于对照组。将IR他克莫司改为LCP他克莫司可改善KT接受者的CBF、脑血管动力学和认知功能。需要更大规模的研究来证实这些结果。
Calcineurin inhibitors are inherent vasoconstrictors. Cerebral vasoconstriction can reduce cerebral blood flow (CBF), and negatively impact cerebrovascular response (CVR) to exercise, and cognitive function. The once-daily extended-release (LCP) tacrolimus has fewer side effects than the immediate-release (IR) tacrolimus. The role of calcineurin inhibitors on CBF and the impact of specific formulations of tacrolimus on CBF, CVR, and cognitive function are unknown. In this pilot study, we evaluated whether changing from IR tacrolimus to LCP tacrolimus modulates CBF, CVR, or cognitive function in kidney transplant (KT) recipients. We randomized (2:1) 30 stable KT recipients on IR tacrolimus to intervention (switch to LCP tacrolimus) and control (continue IR tacrolimus) arms. We measured CBF, CVR, and cognitive function at baseline and at 12 wk. We used ANCOVA to evaluate changes in outcome variables, with baseline values and study arm as covariates. We used descriptive statistics with mean changes in outcome variables to compare the 2 groups. Participants were 51 ± 13 y old. There was no difference in plasma tacrolimus levels at baseline and at 12 wk in the 2 arms. The changes in CBF, resting middle cerebral artery velocity, CVR, and cognitive function were more favorable in the intervention arm than in the control group. Changing IR tacrolimus to LCP tacrolimus may improve CBF, cerebrovascular dynamics, and cognitive function in KT recipients. Larger studies are needed to confirm these results.