两性霉素B和5-氟胞嘧啶联合用药对肝、肾功能的影响

Influence on liver and kidney from combined amphotericin B and flucytosine

目的 :探讨两性霉素 B( AMB)和 5 -氟胞嘧啶 ( 5 - FC)联合治疗新型隐球菌性脑膜炎对肝、肾功能的影响。方法 :用AMB联合 5 - FC治疗新型隐球菌性脑膜炎患者 40例 ,观察用药后肝、肾功能的变化。结果 :治疗患者中有 75 % ( 30 / 40 )出现AL T升高 ,5 5 % ( 2 2 / 40 )出现 AST升高 ,仅有 12 .5 % ( 5 / 40 )出现血清总胆红素升高。分别有 47.5 % ( 19/ 40 )和 2 0 % ( 8/ 40 )的患者出现血尿素氮和血肌酐异常。结论 :AMB联合 5 - FC治疗新型隐球菌性脑膜炎时中毒性肝炎的发生率高 ,但不引起严重的中毒性肝损害。对肾脏的毒性表现为氮质血症 。

AIM: To observe the influence on liver and kidney form amphotericin B combined flucytosine in the treatment of cryptococcus meningitis. METHODS: Forty patients with cryptococcus meningitis treated by amphotericin B combined flucytosine were evaluated. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubine (TBIL), blooduria nitrogen (BUN) and creatinine (Cr) of the patients' blood serum were observed regularly after treatment. RESULTS: The results showed that 75% (30/40) and 55% (22/40) patients appeared increasing of ALT and AST level respectively, and only 12 5% (5/40) patients appeared increasing of TBIL level. And 47 5% (19/40) and 20% (8/40) patients appeared increasing of BUN and Cr level respectively. CONCLUSION: The incidence rate of toxic hepatitis from amphotericin B combined with flucytosine in the treatment of cryptococcus meningitis is high, but the severity is light. The main influence on kidney from amphotericin B combined with flucytosine in the treatment of the patients with cryptococcus meningitis is azotemia. The incidence rate of uremia is very low.