传统两性霉素B和脂质体两性霉素B治疗血液病患者安全性的回顾性队列研究  

Retrospective case-cohort study on safety of amphotericin B versus liposomal amphotericin B for hematological diseases

作　　者：徐芳菲 梁密 黄伟[1] XU Fangfei;LIANG Mi;HUANG Wei(Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Hematology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]华中科技大学同济医学院附属同济医院血液科,武汉430030 [2]北京大学人民医院血液科,北京100044

出　　处：《中国真菌学杂志》2024年第1期8-14,共7页Chinese Journal of Mycology

摘　　要：目的比较传统两性霉素B(conventional amphotericin B,C-AMB)和脂质体两性霉素B(liposomal amphotericin B,L-AMB)治疗血液病患者的安全性。方法收集2016年—2022年于华中科技大学同济医学院附属同济医院血液科接受C-AMB或L-AMB治疗的血液病患者信息,通过倾向性匹配评分分析法将两组患者年龄和性别进行匹配后,比较两组患者治疗过程中出现的药物不良反应。结果两组患者在治疗总时间,因治疗成功或失败而停药的发生率,因低钾血症、肝毒性和肾毒性等不良反应导致停药的发生率均无明显差异。两组患者在肾毒性和低钾血症发生率方面也没有明显差异。但是,两性霉素B的单日最大剂量是影响其相关肾毒性和低钾血症的关键因素。结论C-AMB仍然是一种值得在临床中使用的安全有效的药物,特别是对于经济条件较差、需要接受经验性或抢先抗真菌治疗的血液病患者。Objective To compare the safety of conventional amphotericin B(C-AMB)versus liposomal amphotericin B(L-AMB)for hematological diseases by case-cohort study.Methods The clinical data of 595 cases of hematological diseases treated with C-AMB or L-AMB between 2016 and 2022 in the department of hematology of Tongji Hospital were collected and compared the difference of side effects between these two groups after matching patients’age and sex by propensity score matching analysis.Results There was no difference between C-AMB and L-AMB in the duration of treatment and in the incidence of drug withdrawal owing to either treatment success or treatment failure.And there was no difference between C-AMB and L-AMB in the incidence of drug withdrawal caused by hypokalemia,liver damage,and kidney damage.The difference between patients treated with C-AMB and patients treated with L-AMB in the incidence of renal damage and the incidence of hypokalemia was not statistical significantly.The key factor affecting amphotericin B-induced nephrotoxicity and hypokalemia was the increasing maximum daily dose of amphotericin B.Conclusion C-AMB is still a safe and effective drug that is worthy of clinical use,especially for patients of hematological diseases with poor economic conditions,who need empirical therapy or pre-emptive therapy.

关 键 词：传统两性霉素B 脂质体两性霉素B 药品安全 血液病 

分 类 号：R978.5[医药卫生—药品]