两性霉素B脂质体梯形方案成功治疗复发性黑热病一例

A case of relapse of kala-azar successfully treated by liposomal amphotericin B trapezoid regimen

目的通过对黑热病复发患者两性霉素B脂质体(L-Am B)治疗病例进行回顾性总结,为临床诊疗提供依据。方法回顾性分析患者的临床资料、诊疗经过和实验室指标。结果患者,男性、60岁。6个月前因发热、血常规示血红蛋白、白细胞计数及血小板计数减低、脾脏肿大等经骨髓检测确诊黑热病,予足量锑剂治疗好转。仅间隔5个月,再次出现上述症状,复查骨髓提示黑热病复发,经L-Am B个体化梯形方案给药并小剂量维持(第1日10 mg,约0.15 mg·kg^-1·d^-1;第2日起按照10 mg/d逐日递增,至40 mg/d,约0.6 mg·kg^-1·d^-1小剂量维持,直至达指南推荐剂量)治疗好转,随访3个月无复发。结论L-AmB梯形方案给药并小剂量维持可实现黑热病的病原学治愈。

Objective To provide better diagnosis and therapy through a retrospective summary of a case of low dose maintenance of liposomal amphotericin B(L-AmB)on relapse of kala-azar.Methods The clinical data,treatment course and laboratory indexes of the patient were analyzed,retrospectively.Results A 60-yearsold male,suffered from fever,pancytopenia and splenomegaly six months ago.The patient was diagnosed by kala-azer through bone marrow examination,and improved after treatment of adequate antimonial.The above symptoms occurred after an interval of 5 months.By bone marrow examination,kala-azar was verified again.L-Am B(10 mg at the first day,about 0.15 mg·kg^-1·d^-1;from the second day,the dose gradually increased from 10 mg/d to 40 mg/d,with a low dose of about 0.6 mg·kg^-1·d^-1 until the recommended dose)was used and effective.The L-AmB was constructed as trapezoidal scheme and then kept with a low dose.The patient improved without relapse in three-month follow-up.Conclusion L-AmB constructed as trapezoidal scheme and then kept with a low dose could achieve the etiological cure of kala-azar.