两性霉素B所致肾小管酸中毒的临床分析

Clinical analysis of amphotericin B- induced renal tubular acidosis

目的 :观察长期应用两性霉素B所致肾小管酸中毒 (RTA)的发生率 ,探讨其影响因素及防治原则。方法 :1995年～ 2 0 0 1年间我院应用两性霉素B治疗的隐球菌性脑膜炎病人 5 8例 ,观察其用药前后的临床表现、尿量、尿 pH值以及血、尿电解质变化 ,不典型者通过氯化铵试验证实RTA的存在。结果 :5 8例病人中有 8例发生RTA ,两性霉素B相关性RTA的发生率为 14 % ,出现RTA时累积剂量为 (2 915±s 2 30 4 )mg ,72 8～ 8135mg ,通过两性霉素B减量或停药 ,或者肾毒性药物如甘露醇、磺胺和氨基糖苷类药物的减量或停药 ,可使肾小管酸化功能好转。结论 :RTA的发生和两性霉素B的剂量、肾毒性药物的合用有关。减少或停用上述药物 。

AIM: To observe the incidence of renal tubular acidosis(RTA) induced by amphotericin B, and explore its influencing factors, preventive and treatmental principles. METHODS: Fifty eight patients with cryptococcal meningitis were treated with amphotericin B. Their clinical manifestations, volume, acidity and electrolytes of urine, as well as blood electrolytes before and during the treatment with amphotericin B were monitored. In the untypical patients, the test of ammonium chloride was performed in order to confirm the existence of RTA. RESULTS: In fifty eight patients, there were eight patients suffered from RTA. The incidence of amphotericin B associated RTA was 14 %. The cumulative dosage was (2 915± s 2 304) mg,728 8 135 mg. The acidulated function of renal tube would be improved by decreasing in dosage or withdrawal of amphotericin B, or other nephrotoxic drugs such as mannitol, sulfonamides and aminoglycosides. CONCLUSION: Amphotericin B associated RTA is related to the dosage of amphotericin B and the concurrent medications of nephrotoxic drugs. Decrease in the dosage or withdrawal of these drugs will improve the acidulated function of renal tube.