中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2015年
3期
146-149
,共4页
赵华真%曹亚辉%陈艳琼%郑建铭%胡越凯%王睿莹%王璇%吴吉芹%朱利平
趙華真%曹亞輝%陳豔瓊%鄭建銘%鬍越凱%王睿瑩%王璇%吳吉芹%硃利平
조화진%조아휘%진염경%정건명%호월개%왕예형%왕선%오길근%주리평
脑膜炎,隐球菌性%氟康唑%高剂量%疗效%安全性
腦膜炎,隱毬菌性%氟康唑%高劑量%療效%安全性
뇌막염,은구균성%불강서%고제량%료효%안전성
Meningitis,cryptococcal%Fluconazole%High dose%Efficacy%Safety
目的 探讨高剂量氟康唑(600~800mg/d)单用或联合两性霉素B、氟胞嘧啶在非HIV相关难治性隐球菌脑膜炎(隐脑)补救治疗中的安全性和临床疗效.方法 回顾性分析复旦大学附属华山医院2011年9月至2014年8月资料完整的、高剂量氟康唑治疗1周以上、非HIV相关难治性隐脑患者20例,总结其临床特征,分析其临床疗效、药物不良反应及转归.结果 20例患者中,11例合并基础疾病,起病时主要的临床表现为头痛20例、发热14例、呕吐14例和脑膜刺激征13例,19例患者颅脑MRI或CT异常.高剂量氟康唑补救治疗的中位疗程为80 d(28~440 d).补救治疗结束时,部分应答17例,稳定应答2例,死亡1例,总有效率为85%;抗真菌治疗结束时,完全应答9例,部分应答8例,稳定应答1例,死亡2例,总有效率为85%.此外,在7例患者中观察到11例次高剂量氟康唑可能相关的不良事件,包括肝功能异常、血细胞减少、胃肠道反应等,所有患者均可耐受,未出现因不良反应而减量或停药者.结论 对于初始治疗效果欠佳,或对两性霉素B药物不良反应难以耐受的非HIV相关隐脑,应用高剂量氟康唑具有较好的安全性和疗效.
目的 探討高劑量氟康唑(600~800mg/d)單用或聯閤兩性黴素B、氟胞嘧啶在非HIV相關難治性隱毬菌腦膜炎(隱腦)補救治療中的安全性和臨床療效.方法 迴顧性分析複旦大學附屬華山醫院2011年9月至2014年8月資料完整的、高劑量氟康唑治療1週以上、非HIV相關難治性隱腦患者20例,總結其臨床特徵,分析其臨床療效、藥物不良反應及轉歸.結果 20例患者中,11例閤併基礎疾病,起病時主要的臨床錶現為頭痛20例、髮熱14例、嘔吐14例和腦膜刺激徵13例,19例患者顱腦MRI或CT異常.高劑量氟康唑補救治療的中位療程為80 d(28~440 d).補救治療結束時,部分應答17例,穩定應答2例,死亡1例,總有效率為85%;抗真菌治療結束時,完全應答9例,部分應答8例,穩定應答1例,死亡2例,總有效率為85%.此外,在7例患者中觀察到11例次高劑量氟康唑可能相關的不良事件,包括肝功能異常、血細胞減少、胃腸道反應等,所有患者均可耐受,未齣現因不良反應而減量或停藥者.結論 對于初始治療效果欠佳,或對兩性黴素B藥物不良反應難以耐受的非HIV相關隱腦,應用高劑量氟康唑具有較好的安全性和療效.
목적 탐토고제량불강서(600~800mg/d)단용혹연합량성매소B、불포밀정재비HIV상관난치성은구균뇌막염(은뇌)보구치료중적안전성화림상료효.방법 회고성분석복단대학부속화산의원2011년9월지2014년8월자료완정적、고제량불강서치료1주이상、비HIV상관난치성은뇌환자20례,총결기림상특정,분석기림상료효、약물불량반응급전귀.결과 20례환자중,11례합병기출질병,기병시주요적림상표현위두통20례、발열14례、구토14례화뇌막자격정13례,19례환자로뇌MRI혹CT이상.고제량불강서보구치료적중위료정위80 d(28~440 d).보구치료결속시,부분응답17례,은정응답2례,사망1례,총유효솔위85%;항진균치료결속시,완전응답9례,부분응답8례,은정응답1례,사망2례,총유효솔위85%.차외,재7례환자중관찰도11례차고제량불강서가능상관적불량사건,포괄간공능이상、혈세포감소、위장도반응등,소유환자균가내수,미출현인불량반응이감량혹정약자.결론 대우초시치료효과흠가,혹대량성매소B약물불량반응난이내수적비HIV상관은뇌,응용고제량불강서구유교호적안전성화료효.
Objective To evaluate the clinical efficacy and safety of high-dose fluconazole (600-800 mg/d) used alone or combined with amphotericin B and/or flucytosine as salvage therapy for refractory cryptococcal meningitis (CM) in human immunodeficiency virus (HIV)-uninfected patients.Methods Twenty HIV-uninfected patients with refractory CM who were treated with high-dose fluconazole for over 1 week from September 2011 to August 2014 in Huashan Hospital,Fudan University were retrospectively reviewed.Clinical features including clinical characteristics,clinical responses,drugrelated adverse events,and prognosis were evaluated.Results Of the 20 patients enrolled in this study,11 patients had predisposing factors.Headache (20 cases),fever (14 cases),vomiting (14 cases) and meningeal irritation (13 cases) were commonly seen.Abnormalities of head computor tomography scan and/or magnetic resonance imaging were found in 19 cases.The median course for salvage therapy was 80 d (28-440 d).At the end of salvage therapy,17 patients achieved partial response and 2 patients achieved stable response,while 1 patient died.The overall efficacy rate was 85 %.At the end of antifungal therapy,complete response was achieved in 9 patients,partial response in 8 patients,stable response in 1 patient and death in 2 patients were observed,and overall success rate was 85%.In addition,11 drugrelated adverse events were observed in 7 cases treated with high-dose fluconazole,including abnormal liver function,hemocytopenia,gastrointestinal reaction,etc.However,all these reactions were tolerable and none of the patients endured dosage reduction or drug discontinuance.Conclusion Salvage therapy with high-dose fluconazole may be appropriate for the treatment of refractory CM in HIV-uninfected patients with good efficacy and safety.