目的 探討多層感知機（ MLP）預測模型和他克莫司血藥濃度監(jiān)測在腎移植患者的臨床應用價值。方法 收集亳州市人民醫(yī)院2023年1月—2025年3月185例進行989例次他克莫司血藥濃度監(jiān)測的腎移植患者，分析其臨床療效和安全性。選取其中78例進行CYP3A5^*3基因多態(tài)性檢測的198例次血藥濃度監(jiān)測數(shù)據(jù)，建立MLP血藥濃度預測模型。結(jié)果 臨床療效方面，高治療窗組［谷濃度（ C_min） ＞ 15 ng·mL^-1］平均血藥濃度（ 18.82±4.42） ng·mL^-1；治療窗組（ 5 ng·mL^-1≤C_min≤15 ng·mL^-1）平均血藥濃度（ 7.86±3.48） ng·mL^-1；低治療窗組（ C_min＜5 ng·mL^-1）平均血藥濃度（ 2.85±2.16） ng·mL^-1，達標比例65.42%。安全性方面，不良反應發(fā)生組的血藥濃度范圍高于未發(fā)生組。多重線性回歸分析顯示，患者年齡、體質(zhì)量、給藥劑量、肌酐和總膽紅素是影響他克莫司血藥濃度的主要相關因素。MLP預測模型的損失函數(shù)為0.82，預測值與實測值平均誤差絕對值為0.162 ng·mL^-1，相關系數(shù)R²為0.985，具有良好的預測效果。結(jié)論 血藥濃度監(jiān)測影響腎移植患者的臨床療效和安全性，MLP預測模型預測血藥濃度準確率高，預測值與實測值之間誤差小，效果理想，可輔助臨床他克莫司個體化用藥。

Objective To explore the clinical value of multilayer perceptron (MLP) prediction model and tacrolimus (FK506) blood concentration monitoring in kidney transplant patients. Methods Concentration monitoring data of FK506 from 185 kidney transplant patients at People’s Hospital of Bozhou were collected from January 2023 to March 2025, and the efficacy and adverse reactions of the monitoring results were analyzed. Using 198 concentration monitoring data from 78 kidney transplant patients with CYP3A5^*3 genetic information, an MLP concentration prediction model was established. Results In terms of clinical efficacy, the average therapeutic drug concentration of high therapeutic window group (C_min> 15 ng·mL^-1) was (18.82 ±4.42) ng·mL^-1, (7.86 ±3.48) ng·mL^-1 in the therapeutic window group (5 ng·mL^-1 ≤ C_min ≤ 15 ng·mL^-1) and (2.85 ±2.16) ng·mL^-1 in the low therapeutic window group (C_min < 5 ng·mL^-1). The proportion of meeting the standards was 65.42%. In terms of security, the concentration range of the occurring group was higher than that of the non occurring group. Multiple linear regression analysis showed that patient age, body weight, drug dose administered, Cr and TBIL were the main correlated factors affecting FK506 plasma concentration. The MLP prediction model has a loss function of 0.82, an absolute average error of 0.162 ng·mL^-1 between the predicted value and the measured values, and a scatter plot correlation coefficient R² of 0.985. The model has achieved good prediction performance. Conclusion Blood concentration monitoring has an impact on the clinical efficacy and Security of kidney transplant patients. The use of MLP model has high accuracy in predicting concentration, small error between predicted values and measured values, and ideal results which can assist clinical FK506 individualized medication.

R983

安徽省重點研究與開發(fā)計劃項目（2022e07020066）；亳州市衛(wèi)生健康科研項目（bzwj2023b001）