小剂量两性霉素B脂质体在老年隐球菌性脑膜炎诱导期治疗中的疗效及肾毒性观察

Curative effect and renal toxicity observation on small dose liposomal amphotericin B in treatment of elderly cryptococcal meningitis in induction period

目的 观察小剂量两性霉素B脂质体（1iposomal amphotericin,L-AmB）在老年隐球菌性脑膜炎诱导期治疗中的疗效及肾毒性。方法 回顾性分析2008年1月-2014年12月收治的使用小剂量L-AmB治疗的老年隐球菌性脑膜炎患者14例为观察组,同期住院的使用常规剂量L-AmB治疗的患者17例作为对照组,分析比较两组的差异。结果 两组患者治疗后总有效率、无效率、死亡率比较差异均无统计学意义,但是对照组治疗后的肾功能损害及低钾血症比例仍明显高于观察组,两组比较差异有统计学意义（P〈0.05）;治疗后,观察组肾小球滤过率较治疗前稍下降,差异无统计学意义,而对照组肾小球滤过率较治疗前明显下降,差异有统计学意义（P〈0.05）。结论 小剂量两性霉素B脂质体在老年隐球菌性脑膜炎诱导期治疗中疗效肯定,肾毒性减轻。

Objective To observe the curative effect and renal toxicity of small dose liposomal amphotericin B（L-AmB）in treatment of elderly cryptococcal meningitis in induction period.Methods 14 cases of elderly cryptococcal meningitis treated by small dose L-AmB between January 2008 and December 2014 were reviewed and selected as the observation group.Another 17 elderly cryptococcal meningitis patients treated by regular dose L-AmB in same period of time were chosen as the control group.Differences between the two groups were compared.Results There was no statistically significant difference in total effective rate,non-effective rate and mortality rate of patients in two groups after treatment.However,the renal function damage and proportion of hypokalemia in the control group were evidently higher than those in the observation group with statistical significance（P〈0.05）.After treatment,the glomerular filtration rate in the observation group reduced slightly than that before treatment,without statistical significance;while the glomerular filtration rate in the control group reduced statistically significantly than that before treatment,with statistecal significance（P〈0.05）.Conclusion The curative effect of small dose liposomal amphotericin B is positive in treatment of elderly crvotococcal meningitis in induction period,with reduced renal toxicity.