更昔洛韦和阿昔洛韦治疗成人水痘的疗效比较

Comparison of Effects of Ganciclovir and Acyclovir on Adult Varicella

目的通过比较更昔洛韦与阿昔洛韦治疗成人水痘的临床疗效,探讨较优的水痘抗病毒治疗方案.方法更昔洛韦组(257例)分别给予更昔洛韦5mg/(kg.次)、每日1次或2次静滴治疗;阿昔洛韦组(149例)给予阿昔洛韦10mg/(kg.次)、每日1次或2次静滴治疗.每组均计数退热时间及皮疹结痂时间,并计数两组2d内用药者和2d后用药者退热时间.结果更昔洛韦组退热时间比阿昔洛韦组缩短,治疗后疱疹结痂时间两组无显著性差异.在比较退热时间和疱疹结痂时间上,更昔洛韦5mg/(kg.次)、1次/d较2次/d静滴治疗差异无统计学意义,阿昔洛韦10mg/(kg.次)、1次/d较2次/d静滴治疗差异无统计学意义.更昔洛韦组2d内(包括2d)用药患者较2d后用药患者退热时间明显缩短.结论更昔洛韦较阿昔洛韦可缩短退热时间,较高剂量更昔洛韦或阿昔洛韦不能增加疗效,更昔洛韦较早用药可明显缩短退热时间.

Objective In order to optimize antiviral therapy on adult varicella, the clinical therapeutic effect of gancielovir and aeyelovir was compared. Methods Ganeielovir was given introvenously at dose of 5 mg/kg qd or bid compared with acyclovir 10 mg/kg qd or bid. Duration of pyretolysis and scab forming time were measured. Duration of pyretolysis in patients who accepted therapy before and after 2 days of onset were also examined. Results Duration of pyretolysis after ganciclovir therapy was significantly reduced compared with acyclovir. There was no significant difference in scab forming time between ganciclovir and acyclovir. For both therapy, low dose （ganciclovir 5 mg/kg, qd; acyclovir 10 mg/kg, qd） group and high dose （ganciclovir 5 mg/kg, bid; acyclovir 10 mg/kg, bid） group had similar duration of pyretolysis and scab forming time. For patients who accepted ganciclovir therapy before 2 days of onset, duration of pyretolysis was significantly shortened compared with therapy after 2 days of onset. Conclusion Ganciclovir therapy can reduce duration of fever compared with acyclovir therapy. There is no additional benifit of high dose of antiviral drug. Earlier therapy with ganciclovir can shorten duration of pyretolysis.