两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合治疗隐球菌性脑膜炎的临床回顾性研究

目的 观察两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合治疗非AIDS、非器官移植隐球菌性脑膜炎患者的疗效和安全性,探讨非AIDS、非器官移植隐球菌性脑膜炎患者诱导治疗的新方案.方法 采用回顾性病例对照研究,18例非AIDS、非器官移植隐球菌性脑膜炎患者诱导期分别接受两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合(研究组n=7)与两性霉素B、氟胞嘧啶和氟康唑联合治疗(对照组n=11).比较两组治疗方案在临床症状、体征变化、病死率、病原学转阴率、脑脊液改变等方面的差异及血常规、肝肾功能损害等不良反应发生情况.结果 治疗前研究组和对照组脑脊液新型隐球菌培养阳性分别为5例和8例(P =0.676),治疗1周后分别为5例和8例(P =0.676),治疗2周后分别为2例和4例(P =0.572),治疗3周后分别为0例和1例(P=0.611),治疗4周后,无死亡病例,两组脑脊液新型隐球菌培养均为阴性,脑脊液生化两组之间差异无统计学意义,对照组较研究组丙氨酸氨基转移酶(156.82±41.30 vs 97.00±22.02,P=0.003)、尿素氮(8.45±3.18 vs 5.54±1.28,P=0.020)升高更明显.结论 两性霉素B脂质体、氟胞嘧啶及伊曲康唑联合治疗非AIDS、非器官移植隐球菌性脑膜炎患者疗效确切,安全性较好,可以作为诱导期治疗的选择.

Comparison of liposomal amphotericin B combined flucytosine and itraconazole with amphotericin B combined flucytosine and Fluconazole in the treatment of cryptococcal meningitis

Objective To observe the efficacy and safety of amphotericin B liposomes combined flucytosine and itraconazole in initial treatment of non-AIDS,non-organ transplant patients with cryptococcal meningitis,and evaulate the value of the therapy for the treatment of cryptococcal meningitis.Methods Eighteen patients with non-AIDS,non-organ transplant cryptococcal meningitis received initial treatment as described below: triple therapy with amphotericin B liposomes,flucytosine and itraconazole(study group,n=7);amphotericin B,flucytosine and fluconazole(control group,n=11).Resolution of clinical symptoms,signs,etiology positive rate,fatality rate and side effects were compared between the two groups.ResultsThere were no difference between the two groups in the etiology positive rate at Weeks 0(5/7 vs 8/11,P=0.676),1(5/7 vs 8/11,P=0.676),2(2/7 vs 4/11,P=0.572),3(0/7 vs 1/11,P=0.611) or 4(0 /7 vs 0/11) after treatment.After 4 weeks treatment,the fatality rate of the two groups was 0,there were no difference between the two groups in CSF biochemistry,but there were significant differences between control group and study group in alanine aminotransferase(156.82±41.30 vs 97.00±22.02,P=0.003),blood urea nitrogen(8.45±3.18 vs 5.54±1.28,P=0.020).Conclusion Triple therapy with amphotericin B liposomes combined flucytosine and itraconazole is effective and safe in treatment of non-AIDS,non-organ transplantation patients with cryptococcal meningitis,and can be used as an alternative for eryptoeoecal meningitis in non-AIDS,non-organ transplantation.