复方磺胺甲恶唑单药或联合卡泊芬净治疗耶氏肺孢子菌肺炎患者的疗效与安全性分析  

Efficacy and safety of trimethoprim/sulfamethoxazole monotherapy or combined treatment with caspofungin in the patients with Pneumocystis jirovecii pneumonia

作　　者：丁玲[1] 王玥媛 刘梦颖[3] 李慧[4] 方洁[4] 姚屹瑾[1] DING Ling;WANG Yueyuan;LIU Mengying;LI Hui;FANG Jie;YAO Yijin(Department of Respiratory and Critical Care Medicine,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Pharmacy,Personalized Drug Therapy Key Laboratory of Sichuan Province,The Hospital Affiliated to University of Electronic Science and Technology of China,Sichuan Academy of Medical Sciences,Sichuan Provincial People’s Hospital,Chengdu 610072,China;Department of Pharmacy,Drum Tower Hospital Affiliated to School of Medicine,Nanjing University,Nanjing 210008,China;Department of Pharmacy,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025 [2]四川省医学科学院·四川省人民医院电子科技大学附属医院药学部/个体化药物治疗四川省重点实验室,成都610072 [3]南京大学医学院附属鼓楼医院药学部,南京210008 [4]上海交通大学医学院附属瑞金医院药剂科,上海200025

出　　处：《药学服务与研究》2021年第5期342-346,共5页Pharmaceutical Care and Research

基　　金：上海市卫生健康委员会科研课题面上项目(201940197)。

摘　　要：目的:评估复方磺胺甲恶唑(TMP/SMZ)单药或联合卡泊芬净治疗非人类免疫缺陷病毒(HIV)耶氏肺孢子菌肺炎患者的疗效和安全性。方法:回顾性分析2016年9月-2020年11月上海交通大学医学院附属瑞金医院收治的36例非HIV耶氏肺孢子菌肺炎患者的临床资料。观察组用TMP/SMZ联合卡泊芬净治疗,对照组用TMP/SMZ单药治疗,比较两组患者的临床指标、治疗阳性反应率、全因死亡率及药品不良反应(ADRs)发生情况。结果:观察组患者的血氧分压(PaO_(2))优于对照组,组间差异显著(P=0.041);两组患者的总治疗阳性反应率为75.00%,对照组和观察组的治疗阳性反应率差异无统计学意义(66.67%vs 91.67%,P>0.05);两组患者的总全因死亡率为25.00%,对照组和观察组差异无统计学意义(8.33%vs 33.33%,P>0.05);两组患者的总ADRs发生率为80.56%,对照组与观察组差异无统计学意义(83.33%vs 79.17%,P>0.05)。结论:对于非HIV耶氏肺孢子菌肺炎患者,采用TMP/SMZ单药治疗与联合卡泊芬净治疗的有效率无显著性差异,但联合治疗对于改善PaO_(2)有一定意义。Objective:To evaluate the efficacy and safety of trimethoprim/sulfamethoxazole(TMP/SMZ)monotherapy or combined treatment with caspofungin in the treatment of non-human immunodeficiency virus(non-HIV)patients with Pneumocystis jirovecii pneumonia(PJP).Methods:The clinical data of 36 non-HIV patients with PJP admitted to the Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University from September 2016 to November 2020 were analyzed retrospectively.The observation group was treated with TMP/SMZ combined with caspofungin,while the control group was treated simply with TMP/SMZ.Then,the clinical indicators,positive response rates,all cause mortality and the incidence of adverse drug reactions were compared between the two groups.Results:The blood oxygen partial pressure(PaO_(2))of the observation group was better than that of the control group,with statistical significance when comparisons were made between the 2 groups(P=0.041).The overall positive response rate of the 2 groups was 75.00%,with that of the observation group and the control group being 66.67%and 91.67%respectively(P>0.05).The all cause mortality of the 2 groups was 25.00%,and there was no statistical significance when comparisons were made between the 2 groups(8.33%vs 33.33%)(P>0.05).The overall rate of adverse drug reactions(ADRs)was 80.56%,and no statistical significance could be seen when comparisons were made between the 2 groups(83.33%vs 79.17%,P>0.05).Conclusion:There are no significant differences in the effective rate for the non-HIV patients with PJP treated either with TMP/SMZ monotherapy or combined therapy with caspofungin.However,TMP/SMZ combined with carpofungin might be of clinical significance for improvement of PaO_(2).

关 键 词：耶氏肺孢子菌肺炎 复方磺胺甲恶唑 卡泊芬净 非人类免疫缺陷病毒 疗效 

分 类 号：R978.5[医药卫生—药品] R563.1[医药卫生—药学]