两性霉素B联合氟胞嘧啶与伏立康唑治疗艾滋病合并隐球菌脑膜炎的临床回顾性研究

目的观察两性霉素B联合氟胞嘧啶与伏立康唑治疗艾滋病合并隐球菌性脑膜炎的疗效和安全性,探讨艾滋病合并隐球菌性脑膜炎的新型治疗策略。方法采用回顾性病例对照研究,20例艾滋病合并隐球菌脑膜炎分别接受三联治疗（两性霉素B＋氟胞嘧啶＋伏立康唑,n=10）和传统的两联治疗（两性霉素B＋氟胞嘧啶,n=10）,比较两种治疗方案在降低脑脊液中隐球菌计数的幅度以及临床症状缓解、病死率等方面的差异以及不良反应发生情况。结果治疗2周后,三联治疗患者脑脊液中隐球菌计数下降率明显高于两联治疗患者（下降率分别为0.743和0.408,P=0.009）,三联治疗患者头痛明显减轻或消失的时间短于两联治疗者（分别为12 d和20 d,P=0.009）,两组在2周、4周、8周及12周时的病死率均无统计学差异。两种治疗方案的不良反应发生率相当。结论两性霉素B联合氟胞嘧啶与伏立康唑能有效降低脑脊液中隐球菌计数,可作为艾滋病合并隐球菌脑膜炎诱导期的治疗选择。

Comparison of amphotericin B, flucytosine, and voriconazole with amphotericin B and flucytosine in the treatment of cryptococcal meningitis in AIDS

Objective To compare the efficacy and safety of amphotericin B combimed with flucytosine and voriconazole in initial treatment of AIDS patients with cryptococcal meningitis, and to evaulate the value of voriconazole for the treatment of cryptococcal meningitis in AIDS. Methods Twenty patients with HIV-associated cryptococcal meningitis received initial treatment： triple therapy with amphoteriein B （0.5 mg/kg daily） , flucytosine （ 100 mg/kg daily） , and intravenous vorieonazole （6 mg/kg every 12 hours for the first 24 hours then 4 mg/kg every 12 hours） （study group, n = 10） ; amphotericin B plus flucytosine （control group, n = 10）. Reduction rate of yeast counts in cerebrospinal fluid （CSF）, resolution of clinical symptoms, fatality rate and side effects were compared between the two groups. Results Reduction rate of yeast counts in CSF with triple therapy including amphotericin B, flucytosine and voriconazole was significantly higher than that with amphotericin B plus flucytosine treatment （0. 743 vervus 0.408, P = 0.009）. There were significant differences between the study group and the control group in the mean time of alleviation or resolution of headache （12 days vervus 20 days, P =0.009 ）. There were no differences between the two groups in the prevalence of adverse effects and mortality at 2, 4, 8 or 12 weeks after treatment. Conclusions Triple therapy with amphotericin B, flueytosine plus voriconazole could effectively reduce Cryptococcus neoformans counts in CSF. It is an alternative for cryptococcal meningitis in AIDS.