卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎临床观察

Clinical observation of caspofungin combined with trimethoprim-sulfamethoxazole in treatment of AIDS complicated with pneumocystis pneumonia

目的探讨卡泊芬净联合复方磺胺甲噁唑(TMP-SMZ)治疗艾滋病合并肺孢子菌肺炎(PCP)的临床疗效。方法采集我科收治的102例接受卡泊芬净联合TMP-SMZ治疗的艾滋病合并PCP患者的临床资料,同时选取102例年龄、性别和入院病情相匹配的单独使用TMP-SMZ治疗的患者作为对照,分析两组治疗效果。结果经抗PCP治疗后,联合组动脉氧分压(PaO2)、血浆真菌β-(1,3)-D-葡聚糖和血清乳酸脱氢酶(LDH)的变化分别为(13.4±7.9)mmHg(1mmHg=0.133kPa)、(123.9±84.6)ng/L和(104.5±58.9)U/L,而单药组分别为(10.2±6.7)mmHg、(98.6±83.7)ng/L和(87.3±63.4)U/L,两组比较差异具有统计学意义(P=0.002、0.033、0.046),两组白细胞计数、肝肾功能比较差异无统计学意义(P>0.05);联合组治疗有效率高于单药组(93.1%vs 82.4%,P=0.034)。结论卡泊芬净联合TMP-SMZ在艾滋病合并PCP治疗中疗效优于单独使用TMP-SMZ,值得在临床工作中进一步验证和推广。

Objective To evaluate efficacy of caspofungin combined with trimethoprim-sulfamethoxazole （TMP- SMZ） in treatment of AIDS complicated with pneumocystis pneumonia （PCP）. Methods The study enrolled 102 AIDS patients complicated with PCP who were treated with caspofungin combined with TMP-SMZ. In the meantime, 102 patients treated with TMP-SMZ alone and matched with age, gender and admission condition were selected as control group. The therapeutic efficacy was analyzed between two groups. Results After anti-PCP treatment, changes of PaO2, plasma β-（1,3）-D-glucan and serum LDH in combination treatment group were （13.4± 7.9） mmHg （1 mmHg=0. 133 kPa）, （123.9±84.6） ng/L and （104.5±58.9） U/L, respectively, and those in control group were （10.2± 6.7） mmHg, （98.6 ±83.7） ng/L and （87.3 ± 63.4） U/L, respectively. There were significant differences between two groups （ P =0. 002,0. 033 and 0. 046, respectively）. There were no significant difference in WBC count, liver and kidney function between two groups （ P 〉0.05）. Effective rate was significantly higher in the combined group than that in control group （93.1% vs 82.40%, p = 0. 034）. Conclusion Caspofungin combined with TMP-SMZ is more effective than TMP-SMZ alone in AIDS patients complicated with PCP, which is worthy of further clinical validation.