摘要
目的探讨两性霉素B、氟胞嘧啶联合氟康唑治疗非HIV感染、非器官移植患者隐球菌脑膜炎的疗效和不良反应。方法回顾性分析四川大学华西医院2008-2015年45例非HIV感染、非器官移植后隐球菌脑膜炎患者的临床资料和转归。根据治疗初始时使用两性霉素B联合氟胞嘧啶,同时再联合氟康唑,按此将患者分为二联组和三联组。比较两组治疗效果(成功或失败)、治疗时间、两性霉素B总剂量和不良事件。结果共纳入45例患者,其中二联组18例,三联组27例。两组基线人口统计学和隐球菌脑膜炎疾病严重程度的特征相似。三联组和二联组的成功率分别为81.48%(22/27)和66.67%(12/18),差异无统计学意义(P=0.257)。尽管如此,三联组治疗成功的时间(71.9±37.3)d与二联组(116.0±59.1)d相比,差异有统计学意义(P=0.021);三联组两性霉素B总剂量[(3 090.60±1 540.21)mg]少于二联组[(4 889.89±2 787.48)mg],差异有统计学意义(P=0.035)。三联组不良反应发生率[48.15%(13/27)]低于二联组[77.78%(14/18)],差异有统计学意义(P=0.047)。结论在隐球菌脑膜炎治疗中,采用初始即结合氟康唑的三联疗法相比仅使用两性霉素B联合氟胞嘧啶的二联疗法,可在保证疗效的前提下缩短疗程、降低不良反应发生率,具有临床实践意 义。
Objective To investigate the efficacy and adverse reactions of a combination therapy including amphotericin B,flucytosine and fluconazole in the treatment of cryptococcal meningitis in non-HIV and non-transplant patients.Methods A retrospective study was performed to analyze the outcome of cryptococcal meningitis in 45 non-HIV and non-transplant patients over 8 years in West China Hospital,Sichuan University.Patients were divided into two groups according to the initial therapy.Dual therapy group included 18 patients treated with amphotericin B (AmB) plus flucytosine.The triple therapy group included 27 patients treated with AmB,flucytosine and fluconazole.Treatment outcomes (success or failure),time to treatment success,total dosage of AmB,and adverse events were reviewed and analyzed.Results A total of 45 patients were enrolled into the study (18 in dual therapy group and 27 in triple therapy group).Baseline demography and characteristics of cryptococcal meningitis were similar between the two groups.The cure rate was 81.48% (22/27) in triple therapy group and 66.67% (12/18) in dual therapy group (P=0.257).The time to treatment success in triple therapy group was significantly shorter than that in dual therapy group [(71.9±37.3) vs (116.0±59.1) days;P=0.021].The total dosage of AmB in triple therapy group was lower than that in dual therapy group [(3 090.60±1 540.21) vs (4 889.89±2 787.48)mg;P=0.035].The incidence of adverse events in triple therapy group was 48.15% (13/27),significantly lower than that in dual therapy group (77.78%,14/18) (P=0.047).Conclusions Initial triple therapy comprising amphotericin B,flucytosine and fluconazole may be better than initial AmB plus flucytosine in treating cryptococcal meningitis.The triple therapy is useful in clinical practice because it can shorten duration of treatment and reduce incidence of adverse events without compromising cure rate.
作者
徐助伟
邓雯秋
刘焱斌
XU Zhuwei;DENG Wenqiu;LIU Yanbin(Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第4期396-400,共5页
Chinese Journal of Infection and Chemotherapy
基金
四川省科技厅支撑计划(2018SZ0017)。
