两性霉素B联合氟康唑对获得性免疫缺陷综合征合并新生隐球菌性脑膜炎患者细胞免疫功能的影响

Effect of amphotericin B combined with fluconazole on cellular immune function of acquired immune deficiency syndrome complicated with cryptococcus neoformans causing meningitis

目的探讨两性霉素B联合氟康唑对获得性免疫缺陷综合征(AIDS)合并新生隐球菌性脑膜炎患者细胞免疫功能的影响。方法选取2018年12月至2020年12月首都医科大学附属北京佑安医院收治的AIDS合并新生隐球菌性脑膜炎患者50例,应用随机数字表法分为对照组和观察组,各25例。对照组给予两性霉素B普通输液留置针静脉滴注治疗,观察组给予两性霉素B中心静脉导管置管联合氟康唑治疗。治疗2周为1个疗程,2组均治疗3个疗程。比较2组治疗前后细胞免疫功能和颅内压,临床疗效、置管并发症和不良反应发生率。结果治疗前,2组CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)T淋巴细胞计数和颅内压比较差异均无统计学意义(均P>0.05);治疗后,观察组CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)T淋巴细胞计数均高于治疗前且高于对照组[(1 383±398)个/μl比(1 147±375)个/μl、(846±261)个/μl比(688±232)个/μl、(881±218)个/μl比(598±221)个/μl],2组颅内压均低于治疗前,且观察组低于对照组[(135±33)mmH_(2)O(1 mmH_(2)O=0.098 kPa)比(194±47)mmH_(2)O](均P<0.05)。治疗3个疗程后,观察组总有效率高于对照组[96.0%(24/25)比76.0%(19/25)](P=0.042)。观察组置管渗液渗血和穿刺异常发生率均低于对照组(均P<0.05), 2组不良反应发生率比较差异无统计学意义(P=0.157)。结论两性霉素B联合氟康唑治疗可改善AIDS合并新生隐球菌性脑膜炎患者细胞免疫功能、降低颅内压、提高疗效,且安全性较好。

Objective To investigate the effect of amphotericin B combined with fluconazole on cellular immune function in patients with acquired immune deficiency syndrome(AIDS) complicated with cryptococcus neoformans causing meningitis. Methods Totally 50 patients with AIDS complicated with cryptococcus neoformans causing meningitis admitted to Beijing Youan Hospital, Capital Medical University from December 2018 to December 2020 were enrolled. They were randomly divided into control group and observation group, with 25 cases in each group. The control group was treated with intravenous drip of amphotericin B common infusion indwelling needle, and the observation group was treated with amphotericin B central venous catheter(CVC) combined with fluconazole. One course of treatment was 2 weeks, and both groups were treated for 3 courses. The cellular immune function, intracranial pressure, clinical efficacy, complications and adverse reactions were compared between the two groups before and after treatment. Results Before treatment, there were no significant differences in CD_(3)^(+)、CD_(4)^(+) and CD_(8)^(+)T lymphocyte counts and intracranial pressure between the two groups(all P>0.05). After treatment, the counts of CD_(3)^(+)、CD_(4)^(+) and CD_(8)^(+)T lymphocytes in the observation group were higher than those before treatment and those in the control group [(1 383±398)/μl vs(1 147±375)/μl,(846±261)/μl vs(688±232)/μl,(881±218)/μl vs(598±221)/μl];the intracranial pressure of the two groups was lower than that before treatment, and that of the observation group was lower than that of the control group [(135±33)mmH_(2)O vs(194±47)mmH_(2)O](all P<0.05). After 3 courses of treatment, the total effective rate of the observation group was higher than that of the control group [96.0%(24/25) vs 76.0%(19/25)](P=0.042). The incidences of exudates and bleeding in catheterization and abnormal puncture in the observation group were lower than those in the control group(all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P=0.157). Conclusion Amphotericin B combined with fluconazole can improve cellular immune function, reduce intracranial pressure and improve curative effect in AIDS patients with cryptococcal neoformans causing meningitis.