氟康唑联合氟胞嘧啶治疗隐球菌性脑膜炎10年临床分析

The lO-year clinical analysis of cryptococcal meningitis treated with fluconazole and flucytosine

目的探讨氟康唑（FCZ）联合氟胞嘧啶（5-FC）治疗非AIDS相关隐球菌性脑膜炎的临床疗效。方法回顾性分析52例非AIDS相关隐球菌性脑膜炎患者经两性霉素B（AmB）＋5-FC治疗（32例）与FCZ＋5-FC治疗（20例）的临床特点、疗效和转归，组间比较采用t检验和卡方检验。结果AmB联合5-FC组与FCZ联合5-FC组治疗后的颅内压分别为（221．9±76．2）和（213．4±99．2）mmH2O（1mmH2O=0．0098kPa），脑脊液隐球菌数分别为（351±1180）／mL和（508±943）／mL，脑脊液蛋白含量分别为（0．754±0．726）g／L和（0．649±0．308）g／L，脑脊液白细胞数分别为（16±25）×10^6／L和（28±32）×10^6／L，两组上述指标比较，差异均无统计学意义（t=0．302，t=-0．473，t=0．578，t=-1．348，均P〉0．05）。AmB联合5-FC组治愈率为59．38％（19／32），好转率为6．25％（2／32），未愈或病死率为34．38％（11／32）；FCZ联合5-FC组治愈率为35．00％（7／20），好转率为25．00％（5／20），未愈或病死率为40．000（8／20），两组治愈率、未愈或病死率比较，差异无统计学意义（x2=2．925，x2=0．168；均P〉0．05）。结论FCZ联合5-FC治疗对隐球菌性脑膜炎亦有较好的疗效。

Objective To investigate the therapeutic effects of patients with non-acquired immunodefieiency syndrome （ AIDS ）-related cryptococcal meningitis treated with fluconazole and flucytosine. Methods A retrospective study was conducted including 52 cases of non-AIDS-related cryptococeal meningitis, which were divided into two groups~ the amphotericin B combined with flucytosine group （n = 32） and the fluconazole combined with flucytosine group （n = 20）. The comparison between groups was done by t test and chi-square test. Results The intracranial pressure of the amphotericin B combined with flucytosine group and the fluconazole combined with flucytosine group were （221.9=[=76.2） and （213.4±99.2） mm H2O, respectively （t=0. 302, P〉0.05）, the cryptococcus counts in the cerehrospinal fluid （CSF） were （351 ± 1180） and （508 ± 943）/mL, respectively （t=-0. 473, P〉0.05） the CSF protein levels were （0. 754±0. 726） and （0. 649± 0. 308） g/L, respectively （t=0. 578, P〉0.05） the CSF white blood cell （WBC） counts were （16± 25） ）〈106/L and （28±32））〈108/L, respectively （t=-1. 348, P〉0. 05）. The cured rates were 59.38% （19/32） and 35.00% （7/20）, respectively in the amphotericin B combined with flucytosine group and the fluconazole combined with flucytosine group, and the improved rates were 6. 25% （2/32）and 25.00% （5/20）, respectively, the uncured or mortality rates were 34.38% （11/32） and 40.00% （8/20）, respectively, and the difference were not significant of cured rates （x2 = 2. 925, P〉0.05） and uncured or mortality rates （x2 =0. 168,P〉0.05） between two groups. Conclusion Fluconazole combined with flucytosine also has a good effect on the treatment of cryptococcal meningitis.