CAJ | 학술논문

目的探讨在联合5-氟胞嘧啶的基础上,两性霉素B与氟康唑序贯、联合治疗非AIDS相关隐球菌性脑膜炎的疗效.方法将117例非AIDS相关隐球菌性脑膜炎患者根据治疗方法分为5组,在使用5-氟胞嘧啶的基础上,应用两性霉素B组38例、氟康唑组25例、先氟康唑后两性霉素B组18例、先两性霉素B后氟康唑组15例及联合组21例,比较各组治疗后脑脊液中各指标变化.统计学处理采用t检验,单因素方差分析、多个独立样本检验和卡方检验.结果两性霉素B组、氟康唑组、先氟康唑后两性霉素B序贯组、先两性霉素B后氟康唑序贯组及联合组治疗后的颅内压分别为(208.6±75.1)、(191.5±94.5)、(185.0±76.3)、(201.9±69.7)和(223.1±89.3)mm H2O(1 mm H2O=0.0098 kPa),差异无统计学意义(F=0.611,P=0.656);脑脊液隐球菌中位数分别为0、10、0、3和0个/mL,差异无统计学意义(x2=7.638,P=0.090);脑脊液蛋白水平分别为0.55、0.69、0.67、0.53和0.96 g/L,差异无统计学意义(F=7.063,P=0.133);治愈率分别为55.3％(21/38)、32.0％(8/25)、9/18、6/15和47.6％(10/21),差异无统计学意义(x2=3.638,P=0.457);加重或死亡的比率分别为28.9％(11/38)、44.4％(11/25)、5/18、4/15和23.8％(5/21),差异无统计学意义(x2 =2.785,P=0.604).结论两性霉素B与氟康唑及两者序贯或联合治疗对隐球菌性脑膜炎均有较好的疗效.
목적 탐토재연합5-불포밀정적기출상,량성매소B여불강서서관、연합치료비AIDS상관은구균성뇌막염적료효.방법 장117례비AIDS상관은구균성뇌막염환자근거치료방법분위5조,재사용5-불포밀정적기출상,응용량성매소B조38례、불강서조25례、선불강서후량성매소B조18례、선량성매소B후불강서조15례급연합조21례,비교각조치료후뇌척액중각지표변화.통계학처리채용t검험,단인소방차분석、다개독립양본검험화잡방검험.결과 량성매소B조、불강서조、선불강서후량성매소B서관조、선량성매소B후불강서서관조급연합조치료후적로내압분별위(208.6±75.1)、(191.5±94.5)、(185.0±76.3)、(201.9±69.7)화(223.1±89.3)mm H2O(1 mm H2O=0.0098 kPa),차이무통계학의의(F=0.611,P=0.656);뇌척액은구균중위수분별위0、10、0、3화0개/mL,차이무통계학의의(x2=7.638,P=0.090);뇌척액단백수평분별위0.55、0.69、0.67、0.53화0.96 g/L,차이무통계학의의(F=7.063,P=0.133);치유솔분별위55.3％(21/38)、32.0％(8/25)、9/18、6/15화47.6％(10/21),차이무통계학의의(x2=3.638,P=0.457);가중혹사망적비솔분별위28.9％(11/38)、44.4％(11/25)、5/18、4/15화23.8％(5/21),차이무통계학의의(x2 =2.785,P=0.604).결론 량성매소B여불강서급량자서관혹연합치료대은구균성뇌막염균유교호적료효.
Objective To explore the efficacy of sequential or combined amphotericin B (AmB) and fluconazole (FCZ) therapy on a 5 flucytosine based regimen in non-acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis.Methods A tatal of 117 cases of non-AIDS-related cryptococcal meningitis treated with 5-flurocytosine-based regimens were retrospectively divided into five groups:AmBgroup (n=38),FCZ group (n=25),FCZ and AmB sequential group (n=18),AmB and FCZ sequential group (n=15),AmB and FCZ combination group (n=21).The number in cerebrospinal fluid (CSF) of the five groups were compared.Statistical analyses included t test,oneway analysis of variance,K-independent samples test and chi-square test.Results Intracranial pressure of AmB group,FCZ group,FCZ and AmB sequential group,AmB and FCZ sequential group,AmBandFCZ combination group were (208.6±75.1),(191.5±94.5),(185.0±76.3),(201.9±69.7) and (223.1±89.3) mm H2O (1 mm H2O=0.0098 kPa),respectively,and the differences were not statistically significant (F=0.611,P =0.656).Median cryptococcus counts in CSF of the five groups were 0,10,0,3 and 0/mL,respectively,with no statistical significance (x2 =7.638,P-0.090).CSF protein levels of the five groups were 0.55,0.69,0.67,0.53 and 0.96 g/L,respectively,with no significant differences among groups (F=7.063,P=0.133).The cure rates of the five groups were 55.3％ (21/38),32.0％ (8/25),9/18,6/15 and 47.6％ (10/21),respectively;progression rates or mortality of the five groups were 28.9％ (11/38),44.4％ (11/25),5/18,4/15and 23.8％ (5/21),respectively; and the differences among cure rates (x2 =3.638,P=0.457) and progression rates or mortality (x2-2.785,P =0.604) were not statistically significant.Conclusion FCZ or AmB alone,sequential or combined therapy were all effective in the treatment of cryptococcal meningitis.