常规与小剂量两性霉素B脂质体治疗肾移植受者肺部真菌感染的研究

Comparative study on the clinical outcome following different doses of amphotericin B liposome in the treatment of patients with invasive pulmonary fungal infections after renal transplantation

目的比较小剂量与常规剂量两性霉素B脂质体（L-AraB）治疗肾移植受者侵袭性肺部真菌感染（IPFI）的临床疗效及不良反应。方法回顾性分析2005年1月至2011年3月间26例诊断为IPFI的肾移植受者的资料。患者使用L-AmB治疗，按照药物使用剂量分为小剂量组（0．2～0．5mg·kg^-1·d^-1，19例）和常规剂量组（1～5mg·kg^-1·d^-1，7例）。结果小剂量组药物使用疗程为（20．3±12．7）d，常规剂量组为（19．3±13．2）d，差异无统计学意义（P〉0．05）。小剂量组治疗有效率为84．20o，常规剂量组为57．1％，差异无统计学意义（P〉0．05）。小剂量组用药总量为（414．7±241．7）mg，常规剂量组为（1158．8±928．0）mg，差异有统计学意义（P〈0．05）。常规剂量组6例（85．7％，6／7）发生不良反应，小剂量组4例（21．1％，4／19）发生不良反应，差异有统计学意义（P〈0．05）。结论小剂量L-AmB治疗肾移植术后侵袭性肺部真菌感染患者的效果与常规推荐剂量的治疗效果相当，但小剂量L-AmB治疗者不良反应发生率更低。

Objective To compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome （L-AmB） in the treatment of patients with invasive pulmonary fungal infections （IPFI） after renal transplantation. Methods A total of 26 post- renal transplantation patients with IPFI between Jan. 2005 and Mar. 2011 in Zhujiang hospital received L-AmB treatment identified low doses group （0. 2-0. 5 mg·kg^-1·d^-1, n = 19） or traditional doses group （1-5 mg·kg^-1·d^-1, n = 7） were reviewed. Results The treatment duration in low doses group and traditional doses group was 20. 3 ± 12.7 and 19. 3 ± 13.2 days respectively （P〉0. 05）. The effective rate in low doses group and traditional doses group was 84. 2%and 57. 1 % respectively （P〉 0. 05）. The overall dosage was significantly less in the low doses group （414. 7± 241.7 mg） than in the traditional doses group （1158. 8 ± 928. 0 mg） （P〈0. 05）. The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group （21.1%vs. 85.7%, P〈 0. 05）. Conclusion The effectiveness of low doses of L-AmB protocol in the treatment of IPFI post- renal transplantation patients was similar to that of traditional doses of L-AmB protocol, but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.