复方磺胺甲噁唑联合棘白菌素类药物治疗非艾滋病肺孢子菌肺炎患者的临床疗效及安全性评估  

Clinical efficacy and safety of TMP-SMX combined with echinocandins in the treatment of non-AIDS pneumocystis pneumonia

作　　者：龙爽[1] 牟向东[1] 张成[1] 宿利[1] 贾鹏[1] LONG Shuang;MU Xiang-dong;ZHANG Cheng;SU Li;JIA Peng(Department of Respiratory and ICU, the First Affiliated Hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科

出　　处：《实用药物与临床》2019年第8期808-812,共5页Practical Pharmacy and Clinical Remedies

基　　金：首都卫生科研发展项目(首发2014-4-4072)

摘　　要：目的观察复方磺胺甲噁唑(TMP-SMX)联合棘白菌素类药物治疗非艾滋病肺孢子菌肺炎(PCP)患者的临床疗效及安全性。方法回顾性分析2010年1月至2018年5月我院收治的106例非艾滋病PCP患者的临床病例资料。根据棘白菌素类药物在治疗中联合使用的时间分为一线组和二线组,比较两组患者住院期间无创通气、插管、病死率,好转患者的住院时间及治疗过程中发生的消化道症状、骨髓抑制、肝肾功能损伤、皮疹等不良反应。结果106例非艾滋病PCP患者中,好转66例(62.26%),病死40例(37.74%),发生不良反应56例(52.83%)。采用TMP-SMX治疗时,一线联合棘白菌素类药物的患者插管率低于二线组(32.35%vs.60.00%,P=0.047),有效率高于二线组(50.00%vs.10.00%,P=0.007)。一线组不良反应发生率低于二线组(50.00%vs.70.00%),主要临床表现为消化系统症状和骨髓抑制,其发生率略低于二线组(35.29%vs.42.86%,47.06%vs.50.00%),差异均无统计学意义(P>0.05)。结论采用TMP-SMX治疗非艾滋病PCP患者时,一线联合棘白菌素类药物可能有助于降低插管率,提高临床疗效。Objective To observe the clinical efficacy and safety of TMP-SMX combined with echinocandins in the treatment of non-AIDS pneumocystis pneumonia ( PCP). Methods The clinical data of 106 patients with non- AIDS PCP admitted to our hospital from January 2010 to May 2018 were retrospectively analyzed. The patients were divided into first-line group and second-line group. The non-invasive ventilation, intubation,mortality,hospital stay of patients whose symptoms were improved, and the gastrointestinal symptoms,myelosuppression symptoms, liver and kidney function damage, rash and other adverse reactions during treatment were compared between the two groups. Results Among 106 non-AIDS PCP patients, 66 ( 62. 26%) patients became better, 40 ( 37. 74%) patients died and 56 ( 52. 83%) patients had adverse reactions. The intubation rate of patients in first-line group was lower than that in second-line group ( 32. 35% vs. 60. 00%,P =0. 047),while the effective rate was higher than that in second-line group ( 50. 00% vs. 10. 00%, P =0. 007). The incidence rate of adverse reactions in first-line group was slightly lower than that in second-line group ( 50. 00% vs. 70. 00%), and the main clinical manifestations were digestive system symptoms and bone marrow suppression, whose incidence rates were slightly lower than those in second-line group ( 35. 29% vs. 42. 86%, 47. 06% vs. 50. 00%), the differences being not statistically significant ( P > 0. 05). Conclusion TMP-SMX combined with echinocandins can reduce the intubation rate and improve the clinical efficacy in patients with non-AIDS PCP.

关 键 词：肺孢子菌肺炎 非艾滋病 复方磺胺甲噁唑 棘白菌素类 

分 类 号：R519[医药卫生—内科学]