两性霉素B脂质体成功治疗1例以肾损害为突出表现的黑热病

Liposomal amphotericin B was successfully used to treat a case of kala-azar with prominent renal damage

目的分析两性霉素B脂质体(L-AmB)治疗以肾损害为突出表现的黑热病病例的诊疗过程,为该病的临床诊疗提供理论依据。方法采用回顾性分析方法,对1例于2020年6月30日至西安交通大学第一附属医院感染性疾病科就诊的以肾损害为突出表现的黑热病病例的临床资料、诊疗经过和实验室检查结果进行分析。结果患者女,56岁,出现发热(最高体温38.2℃)、畏寒症状。临床实验室检查结果显示,血红蛋白(55 g/L)、红细胞(2.68×10^(12)个/L)、白细胞(1.06×10^(9)个/L)及血小板计数(8.00×10^(9)个/L)均降低,肾功能示尿素氮及尿肌酐异常,脾大等,经血和骨髓杜氏利什曼原虫检测确诊为黑热病合并肾功能不全。在连续肾脏替代治疗(CRRT)辅助下,经L-AmB小剂量起始缓慢加量并小剂量维持治疗后,患者体温恢复正常,血常规示三系细胞逐渐升高,肾功能示尿素氮及肌酐逐渐下降,脾脏回缩;6个月后复查随访无复发,且肾功能恢复正常。结论L-AmB治疗以肾损害为突出表现的黑热病安全有效,患者不仅病原学治愈,且肾功能得以恢复。

Objective To analyze the diagnosis and treatment process of a kala-azar case with prominent renal damage treated with liposomal amphotericin B(L-AmB),and to provide theoretical basis for clinical diagnosis and treatment.Methods A retrospective analysis method was used to analyze the clinical data,diagnosis and treatment process and laboratory test results of a case of kala-azar with prominent renal damage who presented to the Department of Infectious Diseases,The First Affiliated Hospital of Xi'an Jiaotong University on June 30,2020.Results A 56-year-old female patient presented with fever(the highest body temperature was 38.2℃)and chills.The results of clinical laboratory tests showed that hemoglobin(55 g/L),red blood cell(2.68×10^(12)/L),white blood cell(1.06×10^(9)/L)and platelet count(8.00×10^(9)/L)were decreased,renal function showed abnormal blood urea nitrogen and creatinine,spleen enlargement,etc.,and the diagnosis of kala-azar combined with kidney insufficiency was confirmed by blood and bone marrow Leishmania spp.examination.With the assistance of continuous renal replacement therapy(CRRT),after a small dose of L-AmB was initially and slowly increased and maintained at a low dose,the patient's body temperature was normal,the blood routine showed that the three-lineage cells gradually increased,and the renal function showed blood urea nitrogen and creatinine decreased gradually the spleen was retracted;no recurrence was found at follow-up after 6 months,and renal function returned to normal.Conclusions L-AmB is safe and effective in the treatment of kala-azar with renal damage as the prominent manifestation.The patient is not only cured by etiology,but is also recovered renal function.