两性霉素B三天加量疗法在艾滋病合并隐球菌性脑膜炎中的应用  

Three-day rapid dose escalation therapy of amphotericin B in AIDS patients with cryptococcal meningitis

作　　者：胡志亮[1] 魏洪霞[1] 池云[1] 成骢[1] 程健[1] 陈晨[1] 刘媛[1] 杨永峰[1] 

机构地区：[1]大学附属南京市第二医院感染科,东南210003

出　　处：《中华临床感染病杂志》2014年第4期319-323,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：江苏省卫生厅预防医学科研课题（Y2012073）;南京市医学科技发展项目（YKK12117）

摘　　要：目的评估两性霉素B（AmB）三天加量疗法治疗艾滋病合并隐球菌性脑膜炎（CM）的疗效及患者对其的耐受性。方法回顾性分析南京市第二医院2011年5月至2013年10月收治的使用AmB三天加量疗法治疗的22例艾滋病合并CM患者（25次使用AmB）的资料。分析AmB相关不良反应，如急性输液相关不良反应（发热、畏寒、寒战、恶心、呕吐等），以及剂量累积相关毒性（如肾毒性、电解质紊乱等），并统计患者2周及10周的生存率。结果AmB使用的中位剂量为35（25～50）mg／d，中位疗程为41（10～78）d。患者未出现明显输液相关不良反应。低钾血症是最为突出的不良反应，发生率可达75．0％（18／24）。29．2％（7／24）的患者出现。肾功能检测结果异常，但多较轻微。无一例患者因不良反应需要提前终止AmB诱导治疗。患者2周存活率为100％（21／21），10周存活率为95．2％（20／21）。结论AmB三天加量疗法治疗艾滋病合并CM的疗效明显，患者对其的耐受性较好。Objective To evaluate the efficacy and safety of 3-day rapid dose escalation therapy of amphotericin B （AmB） for AIDS patients with cryptococcal meningitis （CM）. Methods Data on 22 AIDS patients with CM received total 25 coursed of 3-day rapid dose escalation therapy of AmB during May 2011 and October 2013 in Second Affiliated Hospital of the Southeast University were collected. Infusion-related adverse events including fever, chills, rigors, nausea and vomiting, toxicities associated with dose accumulation including nephrotoxicity and electrolyte disturbances, and survival rates in 2 and 10 weeks after initiation of AmB therapy were documented and retrospectively analyzed. Results The median dose and duration of Arab administration were 35 （25-50） mg/d and 41 （10-78） d, respectively. Infusion-related adverse event was not observed during AraB administration. The incidence rate of hypokalemia was 75.0% （18/24） and the rate of mild renal function abnormality was 29. 2% （7/24）. None of the patients prematurely terminated AraB treatment due to adverse events. The survival rates in 2 weeks and 10 weeks were 100.0% （21/21） and 95.2% （20/21） , respectively. Conclusion Three-day rapid dose escalation therapy of AraB is effective and safe for AIDS patients with CM.

关 键 词：两性霉素B 获得性免疫缺陷综合征 隐球菌性脑膜炎 治疗 快速加量 

分 类 号：R512.91[医药卫生—内科学] R519.4[医药卫生—临床医学]