氟康唑在隐球菌脑膜炎治疗中的应用探讨

Application of fluconazole in treatment of cryptococcal meningitis

目的研究氟康唑在隐球菌脑膜炎治疗中的应用效果。方法我院2012年4月～2014年11月收治的40例隐球菌脑膜炎患者。按照简单随机化法将40例患者分为对照组和试验组。对照组以两性酶素B联合氟康唑治疗,试验组以单用氟康唑治疗。观察总有效率、不良反应发生率、治疗前和治疗后患者电解质钾、氯、钙和钠水平的差异,以及脑脊液隐球菌菌数降低情况。结果 （1）试验组和对照组总有效率相似,差异无统计学意义（P〉0.05）;（2）试验组比对照组不良反应发生率更低,差异有统计学意义（P〈0.05）;（3）治疗前两组电解质钾、氯、钙和钠水平相似,差异无统计学意义（P〉0.05）;治疗后两组血钾明显降低,血氯、血钠明显升高,差异有统计学意义（P〈0.05）。而血钙则跟治疗前无明显变化,差异无统计学意义（P〉0.05）。（4）试验组相对照组脑脊液隐球菌菌数降低更显著,差异有统计学意义（P〈0.05）。结论单用氟康唑在隐球菌脑膜炎治疗中的应用效果确切,可有效降低脑脊液隐球菌菌数,但需要加强副作用的监测,做到合理、安全用药。

Objective To investigate the application effect of fluconazole in treatment of cryptococcal meningitis.Methods 40 patients with cryptococcal meningitis treated in our hospital from April 2012 to November 2014. Grouping method： Simple randomization. The 40 patients were divided into control group and study group. Patients in the control group were treated by amphotericin B combined with fluconazole, while patients in the study group were treated by single fluconazole. The overall response rate,incidence rate of adverse reaction,differences in electrolyte levels of potassium, chlorine, calcium, and sodium,reduction of microbial content of cerebrospinal fluid Cryptococcus were observed and compared. Results（1）The overall response rates in the study group and the control group were similar, without significant difference（P〉0.05）;（2）The incidence rate of adverse event was significantly lower in the study group than in the control group（P〈0.05）;（3）The electrolyte levels of potassium, chlorine, calcium, and sodium were similar between two groups before treatment, without significant difference（P〉0.05）; while after treatment, the level of potassium significantly increased and levels of chlorine and sodium significantly reduced in both groups, which was significantly different（P〈0.05）. There was no significant difference in level of calcium before and after treatment（P〉0.05）.（4）The reduction of microbial content of cerebrospinal fluid cryptococcus was more significant in the study group than in the control group（P〈0.05）. Conclusion Single use of fluconazole has definite effect in treatment of cryptococcal meningitis,which can effectively reduce the microbial content of cerebrospinal fluid cryptococcus. But more monitoring on incidence of adverse reactions is needed to ensure its rationality and safety.