伏立康唑联合两性霉素B治疗隐球酵母菌性脑膜炎的疗效与安全性分析

Efficacy and safety of treatment of cryptococcal meningitis with voriconazole combined with amphotericin B

目的分析伏立康唑(VOR)联合两性霉素B(AMB)治疗隐球酵母菌性脑膜炎(CM)的疗效与安全性,为制定合理的临床抗感染方案提供客观依据。方法选取2010年1月-2014年12月350例CM患者作为研究对象,将其随机分为观察组和对照组,每组各175例;观察组患者给予低剂量AMB联合VOR诱导治疗,对照组患者给予低剂量AMB联合氟康唑(FLC)诱导治疗,对两组患者治疗前、治疗后第1、2周的脑脊液(CSF)指标及发热、头痛等症状消退时间、急性期病死率、治疗期间严重不良反应发生率进行比较;应用SPSS13.0软件进行统计分析。结果两组患者经治疗后头痛、发热、恶心呕吐等临床症状均得到逐步缓解,CSF压力>330mm Hg的患者比例较治疗前显著下降,差异有统计学意义(P<0.05);两组患者治疗前、后的CSF指标、发热消退时间、头痛减轻时间、头痛消失比例、急性期病死率、严重不良反应发生率的差异均无统计学意义。结论低剂量AMB联合VOR诱导治疗方案与低剂量AMB联合FLC诱导治疗方案对于CM均具有较好的治疗效果和安全性,均可作为CM治疗的可靠方案。

OBJECTIVE To observe and analyze efficacy and safety of treatment of cryptococcal meningitis（CM）with voriconazole（VOR）combined with amphotericin B（AMB）and to provide objective basis for reasonable clinical anti-infection therapies.METHODS From Jan.2010 to Dec.2014,350 patients with CM were selected as research subjects and randomly divided into observation group and control group.Totally 175 cases were included into each group.Patients in the observation group were treated with inductive treatment of low dose of AMB combined with VOR,and patients in the control group were given inductive treatment of low dose of AMB combined with fluconazole（FLC）.The cerebrospinal fluid（CSF）indexes before treatment,and 1st and 2nd week after treatment;the subsided time of symptoms such as fever and headache;ratio of disappearance of headache;mortality rate in acute phase;incidence of serious adverse effects during treatment of two groups were observed and compared.RESULTS After treatment,clinical symptoms of headache,fever,nausea,vomiting in both two groups were relieved gradually and the ratio of the patients with CSF pressure330mmHg decreased compared with that before treatment,the differences were significant（P〈0.05）.There were no significant differences of CSF indexes,subsided time of fever,relief time of headache,ratio of the headache disappearance,mortality rate in acute phase and the incidences of serious adverse effects between the two groups before and after treatment.CONCLUSIONBoth inductive treatments of CM with low dose of AMB combined with VOR and low dose of AMB combined with FLC have good therapeutic effect and are safe,they can be used in the treatment of CM.