隐球菌性脑膜炎治疗方法的比较

Comparison of antifungal regimens in the treatment of cryptococcal meningitis

目的：比较３种不同抗真菌治疗方法治疗隐球菌性脑膜炎的疗效。方法：可评价的隐球菌性脑膜炎患者２２例，分为３组。Ⅰ组：单用两性霉素Ｂ（ＡＭＢ）静脉滴注或合用氟胞嘧啶；Ⅱ组：单用氟康唑静脉滴注或与氟胞嘧啶合用；Ⅲ组：治疗分二期，前期采用ＡＭＢ静脉滴注与鞘内注射同时应用，或合用氟康唑，直到脑脊液培养转阴。后期应用氟康唑或伊曲康唑维持至脑脊液直接镜检连续３周阴性。结果：Ⅰ组８例患者中５例痊愈，２例好转，１例死亡，１例复发。Ⅱ组４例患者痊愈与死亡各２例，无复发。Ⅲ组１０例患者全部痊愈，无复发。结论：二期治疗法是一种适合治疗隐球菌性脑膜炎的方法。

Objective: To compare the efficacy of three different antifungal regimens in the treatment of cryptococcal meningitis. Methods: Twenty two valuable patients were divided into 3 groups. GroupⅠ was given intravenous (i.v.) amphotericin B (AMB) alone or combined with flucytosine; GroupⅡ received i.v. fluconazole alone or combined with flucytosine. The treatment of group Ⅲ was divided into two stages, where the patients received intrathecal AMB plus i.v. AMB with or without i.v. fluconazole until the mycological culture of CSF turned negative, followed by oral fluconazole or itraconazole as maintenance therapy until direct microscopic examination of CSF showed negative once a week for three consecutive weeks. Results: Of the 8 patients in group Ⅰ,5 were cured,2 improved, one died and one relapsed. Of the 4 patients in group Ⅱ,2 were cured, and 2 died. All the 10 patients in group Ⅲ were cured without any recurrence. Conclusion: The two stage therapeutic regimen may be well suited to the treatment of cryptococcal miningitis.