伊曲康唑治疗隐球酵母菌性脑膜炎临床疗效观察

目的 观察研究伊曲康唑治疗隐球酵母菌性脑膜炎疗效及安全性.方法 选择2000年1月-2009年1月收住院的隐球酵母菌性脑膜炎患者临床资料,进行回顾性统计分析；依据治疗用药的方案分为3组,A组:应用两性霉素B(AmB)、5-氟胞嘧啶(5-FC)联合治疗；B组:应用伊曲康唑与AmB、5-FC联合治疗；C组:应用AmB联合5-FC治疗后,伊曲康唑口服序贯治疗；随访观察治愈、好转、死亡率、复发以及不良反应等,进行组间统计比较.结果 共纳入108例患者,所有患者均经病原学确诊；纳入A组45例、B组21例、C组42例；A组治愈16例占36.0％、好转11例占27.0％、死亡9例占20.0％；B组治愈9例占41.5％、好转7例占33.3％、死亡5例占23.8％；C组治愈24例占56.3％、好转13例占31.0％、、死亡2例占4.8％；3组患者均随访1～3年,A组复发6例占10.3％,B组未出现复发,C组3例复发占7.1％；3组患者的不良反应差异无统计学意义.结论 伊曲康唑应用于治疗隐球酵母菌性脑膜炎临床疗效好,安全可靠,可减少复发率和不良反应.

Clinical efficacy of itraconazole in treatment of cryptococcal meningitis

OBJECTIVE To observe the clinical efficacy and safety of itraconazole in treatment of cryptococcal meningitis.METHODS The clinical data of the patients with cryptococcal meningitis who enrolled in hospital from Jan 2000 to Jan 2009 were retrospectively analyzed,all the patients,according to the different therapeutic programs,were divided into three groups:the patients of group A were treated with amphotericin B(AmB) plus flucytosine(5-FC),the patients of group B received therapy with AmB,5-FC and itraconazole,while the patients of group C were sequentially administered with oral solution of itraconazole after treatment with AmB and 5-FC for several months,the cure,improvement,mortalities,recurrence,and the adverse effects were observed and statistically analyzed.RESULTS A total of 108 patients with cryptococcal meningitis were enrolled in the study,including 45 cases in group A,21 cases in group B and 42 cases in group C,all the patients were aetiologically diagnosed by means of positive test of Cryptococcus;there were 16(36.0%) cases in group cured,11(27.0%) cases improved,9(20.0%) cases dead;there were 9(41.5%) cases in group B cured,7(33.3%) cases improved,5(23.87%) cases dead;there were 24(56.3%) cases in group C cured,13(31.0%) cases improved,2(4.8%) cases dead;follow-up was performed for 1-3 years,there were 6(10.3%) cases with recurrence in group A,there were no recurrence in group B and 3(7.1%) cases of recurrence in group B;the differences in the adverse reactions among the 3 groups of patients was not statistically significant.CONCLUSION Itraconazole is effective and safe in treatment of cryptococcal meningitis,which can reduce the recurrence rate and the adverse reactions.