两性霉素B外用对艾滋病合并马尔尼菲蓝状菌病皮疹的作用

Effect of external use of amphotericin B on penicilliposis marneffei rashes with AIDS

目的 研究外用两性霉素B（AMB）对加快艾滋病合并马尔尼菲蓝状菌病患者皮疹愈合的作用和安全性.方法 将具有皮疹的艾滋病合并马尔尼菲蓝状菌病患者随机分为治疗组与对照组,在常规抗真菌治疗基础上,治疗组予0.25％AMB溶液,而对照组予维生素K1外涂皮疹,观察皮疹消退时间及不良反应.结果 治疗组与对照组各25例,两组患者的年龄、性别分布、HIV感染途径、基线CD4^＋T细胞计数、皮疹分布范围、接受AMB静脉治疗的时间及抗真菌治疗后马尔尼菲蓝状菌培养转阴时间无明显差异（P值均〉0.05）.治疗组皮疹消失时间（10.2±4.2）d,明显短于对照组的（21.1±7.3）d,差异有统计学意义（t=-6.147,P〈0.01）;治疗组的皮疹治愈率明显优于对照组：治疗2周84％：28％（x2=6.818,P〈0.01）,治疗3周100％：64％（x2=15.909,P〈0.01）.而且外用稀释的AMB未给患者带来局部皮肤及全身的任何不良反应.结论 外用0.25％AMB溶液能加快艾滋病合并马尔尼菲蓝状菌病皮疹愈合,且无明显不良反应.

Objective To investigate the efficacy and safety of external use of amphotericin B （AMB） on accelerating the healing of penicilliposis marneffei rashes with AIDS. Methods Patients with a rash of AIDS combined with penicilliposis marneffei were randomly divided into treatment group and control group. On the basis of conventional antifungal therapy, the treatment group was given diluted AMB （0.25%） liquid while the control group was given vitamin K1 to smear rash, and dissipated time and adverse reactions were observed. Results Each group （treatment group and control group） included 25 cases. Patients＇ ages, gender distributions, HIV infection, baseline CD4＋T lymphocyte count, distribution ranges of rash, intravenous AMB treatment time and the Penicillium marneffei clearance time after receiving anti-fungal treatment of two groups had no significant difference （P all〉0.05）. The time of skin rash disappeared in the treatment group was significantly shorter than that in the control group [（10.2 ± 4.2） days versus （21.1 ± 7.3） days, t=-6.147, P〈0.01]. The cure rate in treatment group was better than that in control group： 84% versus 28% after 2-week-treatment （x^2=6.818,P〈0.01）, 100% versus 64%after 3-week-treatment（x^2=15.909,P〈0.01）. Furthermore, external use of diluted AMB did not cause any local skin and systemic adverse reactions. Conclusions External use of diluted AMB （0.25%） liquid can safely accelerate the healing of penicilliposis marneffei rashes with AIDS.