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两性霉素B联合泊沙康唑治疗艾滋病合并隐球菌性脑膜炎的有效性及安全性
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| 篇名： | 两性霉素B联合泊沙康唑治疗艾滋病合并隐球菌性脑膜炎的有效性及安全性 |
| TITLE： | Efficacy and safety of amphotericin B combined with posaconazole in the treatment of cryptococcal meningitis complicated with AIDS |
| 摘要： | 目的 观察两性霉素B联合泊沙康唑治疗艾滋病合并隐球菌性脑膜炎（CM）的有效性和安全性。方法回顾性收集2021年1月至2023年6月重庆市公共卫生医疗救治中心、陆军军医大学第一附属医院收治的44例艾滋病合并CM患者资料，根据治疗方案的不同分为两性霉素B联合氟胞嘧啶（AmB+FC）组和两性霉素B联合泊沙康唑（AmB+POS）组，每组各22例。AmB+FC组患者给予注射用两性霉素B+氟胞嘧啶注射液，AmB+POS组患者给予注射用两性霉素B+泊沙康唑注射液。治疗12周后观察两组患者的临床疗效、临床症状、脑脊液隐球菌转阴率，以及治疗前后的实验室检查结果，并记录两组患者的不良反应发生情况。结果治疗12周后，两组患者的总有效率，发热、视物模糊发生率以及白细胞减少、贫血、肾功能异常、低钾血症、肝功能异常、皮疹、周围神经病变发生率比较，差异均无统计学意义（P＞0.05）。AmB+POS组患者的脑脊液隐球菌转阴率显著高于AmB+FC组，头痛、恶心呕吐发生率以及任何不良事件发生率均显著低于AmB+FC组（P＜0.05）。两组患者的脑脊液压力、脑脊液蛋白含量均显著低于同组治疗前，脑脊液葡萄糖含量、脑脊液氯化物含量均显著高于同组治疗前（P＜0.05）；但两组间比较，差异均无统计学意义（P＞0.05）。结论两性霉素B联合泊沙康唑可提高艾滋病合并CM患者的脑脊液隐球菌转阴率，缓解临床症状，且安全性较好。 |
| ABSTRACT： | OBJECTIVE To observe the efficacy and safety of amphotericin B combined with posaconazole in the treatment of patients with AIDS combined with cryptococcal meningitis （CM）. METHODS The data of 44 patients with AIDS combined with CM admitted to Chongqing Public Health Medical Center and the First Affiliated Hospital of Army Military Medical University from January 2021 to June 2023 were collected retrospectively. They were divided into amphotericin B combined with flucytosine （AmB+FC） group and amphotericin B combined with posaconazole （AmB+POS） group according to treatment regimen， with 22 cases in each group. AmB+FC group was given Amphotericin B for injection+Flucytosine injection； AmB+POS group was given Amphotericin B for injection+posaconazole injection. After 12 weeks of treatment， clinical efficacies of two groups， clinical symptoms and the negative coversion rate of cerebrospinal fluid， and laboratory test results before and after treatment were observed in 2 groups， and the occurrence of adverse drug reactions was recorded in 2 groups. RESULTS After 12 weeks of treatment， the total effective rate， the incidences of fever， blurred vision， leukopenia， anemia， renal function abnormalities， hypokalemia， liver function abnormalities， rash， and peripheral neuropathy were compared between the two groups， and the differences were not statistically significant （P＞0.05）. The negative coversion rate of cerebrospinal fluid in AmB+POS group was significantly higher than AmB+FC group； the incidences of headache， nausea and vomiting symptoms， and the incidence of any adverse events were significantly lower than AmB+FC group （P＜0.05）. The cerebrospinal fluid pressure and cerebrospinal fluid protein content of the two groups were significantly lower than those before treatment， and the cerebrospinal fluid glucose content and cerebrospinal fluid chloride content were significantly higher than those before treatment （P＜0.05）； however， the differences were not statistically significant between 2 groups （P＞0.05）. CONCL USIONS Amphotericin B combined with posaconazole improves the negative coversion rate of cerebrospinal fluid and relieves clinical symptoms in patients with AIDS combined with CM with good safety. |
| 期刊： | 2024年第35卷第16期 |
| 作者： | 张露；鲁雁秋；刘丹；胡婧 |
| AUTHORS： | ZHANG Lu，LU Yanqiu，LIU Dan，HU Jing |
| 关键字： | 隐球菌脑膜炎；人类免疫缺陷病毒；两性霉素B；泊沙康唑；氟胞嘧啶；有效性；安全性 |
| KEYWORDS： | cryptococcal meningitis； human immunodeficiency virus； amphotericin B； posaconazole； flucytosine； efficacy； |
| 阅读数： | 6 次 |
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