【摘要】 目的:观察静脉用二性霉素B(AmB)及其脂质体(L-AmB)对侵袭性真菌感染(IF I)的临床疗效及安全性。方法:46例IF I的原发基础病包括血液病32例及非血液系统疾病14例。普通AmB用量为0.5~1.0 m g/(kg.d),L-AmB用量为0.5~2.0 m g/(kg.d),总剂量为215~2950m g,中位数455m g,疗程10~119d,中位数17d。并对进口AmB、L-AmB及国产AmB的抗真菌疗效和副作用进行了比较分析。结果:二性霉素B临床总有效率为73.9%,真菌清除率为71.0%。进口AmB、L-AmB及国产AmB的治疗有效率分别为76.5%、71.5%及73.3%。不良反应发生率中寒颤、发热19.6%,低血钾21.7%,肝、肾功能损害各为10.9%和15.2%。结论:早期诊断、早期治疗及经验性治疗是提高IF I患者生存率、降低死亡风险的关键。只要预防得当,合理用药,定期监测肝肾功能,二性霉素B仍是一相对较为安全有效的药物。更多还原

【Abstract】 Objective: To observe the clinical efficacy and safety of conventional amphotericin B and liposomal amphotericin B in the treatment of invasive fungal infections.Methods: 46 patients(hematologic disorders 32,other system diseases 14) with invasive mycoses were given intravenous amphotericin B(AmB) 0.5~1.0 mg/(kg·d) or liposomal AmB 0.5~2.0 mg/(kg·d) for 10～119 days(median treatment duration 17 days).Even at daily doses as high as 215～2950mg,and median cumulative doses of 455 mg,AmB was administered to all patients as empirical antifungal therapy.We conducted a study comparing antifungal efficacy and side effects of conventional AmB versus liposomal AmB in the treatment of invasive mycoses. Results: The clinical efficacy rate of AmB was 73.9%,and the fungal elimination rate was 71.0%.The outcomes of imported AmB and liposomal AmB and domestic AmB were similar with respect to antifungal efficacy rate(76.5%,71.5% and 73.3%,respectively).Among the adverse reactions,chill and fever were present in 19.6% of the patients.Hypokalaemia was found in 21.7%,hepatotoxicity in 10.9% and nephrotoxicity in 15.2%.Conclusion: AmB should be the first choice for antifungal therapy,and early prophylaxis,early diagnosis and empirical treatment are the key to get a higher survival rate.If it is used properly and hepatic and renal function tests are carried out regularly,AmB is a relatively safe and effective drug.更多还原