伏立康唑与两性霉素B脂质体治疗艾滋病合并播散性马尔尼菲青霉菌病的对照研究  

Comparative study of voriconazole and liposomal amphotericin B in the treatment of disseminated penicilliosis marneffei in patients with acquired immunodeficiency syndrome

作　　者：何浩岚[1] 董永新[1] 蔡卫平[1] 陈谐捷[1] 李凌华[1] 聂静敏[1] 唐小平[1] 

机构地区：[1]广州市第八人民医院感染病科,广东广州510060

出　　处：《热带医学杂志》2011年第8期924-926,共3页Journal of Tropical Medicine

基　　金：国家"十一五"科技重大专项(2008ZX10001-006;2008ZX10001-008);广东省医学科研基金(A2010479);广州市医药卫生科技项目(2009-YB-090)

摘　　要：目的比较伏立康唑和两性霉素B脂质体治疗艾滋病(AIDS)合并播散性马尔尼菲青霉菌病(PSM)的疗效及安全性。方法对经血/骨髓培养确诊为AIDS合并PSM的患者,分别给予伏立康唑和两性霉素B脂质体治疗,疗程28d,比较两组的疗效和安全性。结果共52例患者纳入研究,其中伏立康唑治疗组20例,两性霉素B脂质体治疗组32例。治疗14d和28d时,伏立康唑组和两性霉素B脂质体组的治疗有效率分别为40.0%、65.0%和56.3%、71.9%,两组比较差异均无统计学意义(Z=1.300,P=0.254;Z=0.273,P=0.601),但两组28d的治疗有效率均明显高于14d(Z=3.994,P=0.046)。治疗过程中,两组均未出现因毒副作用停药的现象,但两性霉素B脂质体组临床毒副反应较重且出现了血清肌酐的升高。结论伏立康唑与两性霉素B脂质体均为治疗AIDS合并PSM的有效方法,但伏立康唑安全性更好。Objective To compare the efficacy and safety of voriconazole and liposomal amphotericin B in the treatment of disseminated penicilliosis marneffei （PSM） in patients with acquired immuno deficiency syndrome （AIDS）.Methods Fifty-two AIDS patients complicated with disseminated PSM infection were enrolled in the study.Of them,20 patients received voriconazole and 32 received liposomal amphotericin therapy.The course of treatment was 28 days.The efficacy and safety between the two groups were compared.Results The effective rates after 14 days and 28 days treatment in voriconazole group were 40.0% and 65.0%,respectively,while those in liposomal amphotericin group were 56.3% and 71.9%,respectively.There was no statistical significance between the two groups （Z=1.300,P=0.254;Z=0.273,P=0.601）.The differences in effective rates between 14 days and 28 days treatment were statistically significant in both voriconazole and liposomal amphotericin group（Z=3.994,P=0.046）.During the treatment,none of the patients discontinued therapy due to adverse effects.The side effects were relatively severer and the serum creatinine level significantly increased in liposomal amphotericin group.Conclusion Both voriconazole and liposomal amphotericin B are effective in the treatment of PSM in AIDS patients,and voriconazole has less adverse effect.

关 键 词：艾滋病 马尔尼菲青霉菌病 伏立康唑 两性霉素B脂质体 

分 类 号：R512.91[医药卫生—内科学]