伏立康唑与两性霉素B治疗AIDS合并马尔尼菲蓝状菌病的疗效及安全性对比

Comparison of efficacy and safety of voriconazole and amphotericin B in the treatment of AIDS combined with Talaromycosis marneffei

目的:对比伏立康唑与两性霉素B治疗艾滋病(AIDS)合并马尔尼菲蓝状菌病的临床疗效及安全性。方法:选取2013年1月至2017年4月广西医科大学附属广西民族医院和广西医科大学第一附属医院收治的64例AIDS合并马尔尼菲蓝状菌病患者,按随机数字表法分为观察组和对照组,每组32例。两组均给予常规高效抗逆转录病毒治疗及降酶护肝、纠正电解质紊乱等对症治疗,在此基础上,观察组给予伏立康唑口服治疗,对照组给予两性霉素B静脉滴注治疗。比较两组临床疗效、血/骨髓真菌培养转阴率、血常规及肝、肾功能指标。结果:治疗4周后,观察组治疗总有效率为90.63%,明显高于对照组的68.75%(P<0.05)。观察组血/骨髓真菌培养转阴率、血红蛋白(Hb)、血小板计数(PLT)和肌酐清除率(Ccr)均高于对照组,白细胞计数(WBC)、总胆红素(TBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和血肌酐(Scr)水平低于对照组,差异均有统计学意义(均P<0.05)。两组尿素氮(BUN)水平比较差异无统计学意义(P>0.05)。结论:伏立康唑治疗AIDS合并马尔尼菲蓝状菌病的临床疗效优于两性霉素B,更有利于患者肝功能恢复,对肾功能的损伤小,值得临床推广应用。

Objective:To compared the efficacy and safety of voriconazole and amphotericin B in the treatment of AIDS combined with Talaromycosis marneffei(TSM). Methods:A total of 64 AIDS combined with TSM patients in our hospital from January 2013 to April 2017 were selected, and randomly assigned to receive either conventional treatment and amphotericin B (control group, n =32) or conventional treatment and voriconazole(observation group, n =32). The clinical efficacy, the negative conversion rate of fungus cultured in blood or bone marrow, blood routine examination and liver and kidney function indexes were detected and compared. Results:After 4 weeks of treatment, the total effective rate of the observation group was 90.63%, which was significantly higher than that of the control group(68.75%)( P <0.05). The negative conversion rate of fungus cultured in blood or bone marrow, hemoglobin(Hb) level, platelet count(PLT) and creatinine clearance rate(Ccr) were higher in the observation group than those in the control group, while the white blood cell count and the levels of total bilirubin(TBil), alanine aminotransferase(ALT), aspartate aminotransferase(AST) and serum creatinine(Scr) were lower( P <0.05). No significant difference was found in the urea nitrogen(BUN) level between the two groups( P >0.05). Conclusion:Voriconazole had better curative effect on AIDS combined with TSM than amphotericin B, and it could be more effective in promoting the recovery of liver function and had less impact on renal function.