不同剂量两性霉素B诱导治疗艾滋病相关性隐球菌脑膜炎的安全性及有效性分析

Safety and efficacy of standard and low doses of amphotericin B in the treatment of HIV-associated cryptococcal meningitis

目的探讨在艾滋病人群中不同剂量两性霉素B诱导治疗隐球菌脑膜炎的安全性及有效性,为优化艾滋病相关性隐球菌脑膜炎的诊疗提供参考。方法收集2019年1月—2022年3月入住上海市公共卫生临床中心明确诊断为艾滋病相关性隐球菌脑膜炎患者,根据两性霉素B使用剂量分为标准剂量组和低剂量组,收集治疗前后临床检测结果、临床预后以及药物不良反应进行回顾性分析。结果共入组57例患者,其中标准剂量组(0.7mg·kg^(-1)·d^(-1))25例,低剂量组(0.4~0.5 mg·kg^(-1)·d^(-1))32例,两组患者3级以上药物不良反应发生率相似(P=0.186),主要包括低钾血症、贫血、肝功能异常、中性粒细胞减少、血小板减少。标准剂量两性霉素B可以显著缩短脑脊液隐球菌培养转阴时间(P<0.001)。两组患者的住院时间(P=0.921)及90 d病死率(P=0.717)差异无统计学意义。结论该院收治的艾滋病人群中使用标准剂量两性霉素B诱导治疗隐球菌脑膜炎可以有效加快脑脊液中隐球菌培养转阴时间,且不会增加严重不良反应的发生率。

Objective To examine the safety and efficacy of different doses of amphotericin B in the treatment of cryptococcal meningitis in AIDS population for optimizing the dosing regimen to improve patient outcomes.Methods The patients with HIV-associated cryptococcal meningitis who admitted to Shanghai Public Health Clinical Center from January 2019 to March 2022 were identified.The patients were assigned to standard-dose or low-dose group according to their amphotericin B dose.The clinical manifestations,laboratory test results,and adverse effect were collected and analyzed retrospectively.Results Overall,57 HIV patients were enrolled,including 25 patients receiving standard-dose(0.7 mg·kg^(-1)·d^(-1))and 32 receiving low-dose amphotericin B(0.4-0.5 mg·kg^(-1)·d^(-1)).The incidence of adverse effect was similar in the two dose groups(P=0.186),including hypokalemia,anemia,abnormal liver function tests,neutropenia,and thrombocytopenia.Standard-dose amphotericin B significantly shortened the time to negative Cryptococcus culture in CSF(P<0.001).Hospital stay(P=0.921)and 90-day mortality(P=0.717)did not show significant differences between the two groups.Conclusions Compared with low-dose regimen,standard-dose amphotericin B can effectively shorten the time to negative Cryptococcus culture in CSF in the treatment of HIV-associated cryptococcal meningitis without increasing adverse effect.