两性霉素B治疗124例AIDS合并隐球菌脑膜炎的有效性及安全性研究

摘要/Abstract

摘要：

目的观察两性霉素B （AmB）联合5-氟胞嘧啶（5-FC）治疗AIDS相关性隐球菌脑膜炎的疗效及安全性。方法对2013年1月~2018年7月因AIDS在成都市公共卫生临床医疗中心住院，诊断为隐球菌脑膜炎，接受AmB+5FC治疗满2周的124名患者的病例资料进行回顾性分析。结果 124例中85.48%为男性，平均年龄（38.85±11.22）岁。平均病程（22.40±17.75） d，最常见的临床症状为头痛（89.52%）、发热（47.58）、恶心呕吐（38.71%）。107例未接受ART患者入院时平均CD4⁺T淋巴细胞计数18（9，41） cells/μL，血浆HIV RNA 1.38（0.46，4.74）×10⁵copies/mL。62.9%的患者初次脑脊液压力>250 mmH₂O。AmB导入治疗时间（4.97±1.13） d，平均治疗时间（33.42±13.53） d。治疗2周脑脊液细胞数及蛋白含量较治疗前下降，葡萄糖较治疗前上升，差异有统计学意义（P<0.05）。脑脊液隐球菌培养2周阴转率87.10%（108/124），4周阴转率96.77%（120/124）。2.42%（3/124）的患者因发生重度药物不良反应而更换AmB。4周病死率为6.45%，12周病死率为12.90%。结论在密切监测血常规、肝肾功、电解质的情况下，短期使用AmB联合5-FC治疗AIDS合并隐球菌脑膜炎患者耐受性好，疗效佳。

关键词: AIDS, 隐球菌脑膜炎, 两性霉素B, 有效性

Abstract:

Objective To observe the efficacy and safety of amphotericin B combined with 5-FC in the treatment of AIDS-associated cryptococcal meningitis. Methods We prospectively enrolled 124 AIDS adults with cryptococcal meningitisand received treatment with amphotericin B + 5FC over 2 weeks, who presented to the public health clinical center of Chengdu from January 2013 to July 2018. Results The mean age of 124 patients was (38.85 + 11.22) years old. Mean course of disease was (22.40 + 17.75) days. The most common clinical symptoms were headache (89.52%), fever (47.58), nausea and vomiting (38.71%).The median CD4⁺T lymphocyte count and plasma HIV RNA of 107 ART-naïve patients were 18 cells/μl and 1.38×10⁵ copies/ml. 62.9% patients had a cerebrospinal fluid pressure higher than 250 mmH₂O. AmB infusion treatment time was (4.97 + 1.13) days, and the average treatment time was (33.42 + 13.53) day. The number of cerebrospinal fluid cells and protein content decreased at 2 weeks after treatment compared with that before treatment, while glucose increased. It showed a significant difference (P<0.05). The negative conversion rate of CSF culture was 87.10% at 2 weeks and 96.77% at 4 weeks.2.42% (3/124) patients discontinued AmB due to severe adverse drug reactions. Mortalities were 4.03% at 4 weeks and 12.90% at 12 weeks. Conclusion A short-term use of AmB combined with 5-FC in the treatment of AIDS-associated cryptococcal meningitis was effective and safety. Blood test, liver function, kidney function and electrolyte should be closely monitored during the treatment.

Key words: AIDS, cryptococcal meningitis, amphotericin B, efficacy

中图分类号:

R519.4

何沅鸿, 谭清, 杨彤彤, 何盛华, 王印, 周锐峰, 蔡琳. 两性霉素B治疗124例AIDS合并隐球菌脑膜炎的有效性及安全性研究[J]. 中国真菌学杂志, 2019, 14(6): 346-350.

HE Yuan-hong, TAN qing, YANG Tong-tong, HE Sheng-hua, WANG Yin, ZHOU Rui-feng, CAI Lin. Efficacy and safety of amphotericin B in 124 AIDS-associated cryptococcal meningitis patients[J]. Chinese Journal of Mycology, 2019, 14(6): 346-350.

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