青蒿琥酯与阿奇霉素伍用治疗疟疾的疗效观察

发布时间：2018-02-10 18:33

本文关键词： 青蒿琥酯阿奇霉素疟疾间日恶性疗效　出处：《大理学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的： 1.观察青蒿琥酯与阿奇霉素伍用治疗疟疾的疗效； 2.观察标准的间日疟(恶性疟)治疗方法治疗当地间日疟(恶性疟)的疗效； 3与标准的间日疟、恶性疟疾疗法比较，评价青蒿琥酯与阿奇霉素伍用治疗疟疾的疗效；方法:在云南省中缅边境西部地区拉咱和瑞丽市弄岛镇两地设立观察点，主要观察青蒿琥酯与阿奇霉素伍用杀灭人体红内期疟原虫作用。对涂片镜检确诊的单一感染间日疟或恶性疟的患者严格按照筛选条件入选。间日疟分A组（青蒿琥酯与阿奇霉素观察组）和B组（标准的氯伯8d疗法作对照组）；恶性疟分C组（青蒿琥酯与阿奇霉素观察组）和D组（标准的双氢青蒿素哌喹疗法作对照组）。按照患者就诊顺序1:1随机编号入组，A组和C组用青蒿琥酯与阿奇霉素伍用3d治疗，B组用磷酸氯喹片3d磷酸伯氨喹8天治疗，D组用双氢青蒿素哌喹片3d治疗。间日疟用药后24h、48h，观察/计数疟原虫减少率、1周临床治愈率，根治率持续观察3个月，且观察病人体温恢复正常时间；恶性疟观察用药后24h、48h，观察/计数疟原虫减少率、1周临床治愈率、28d治愈率。观察结果用SPSS16.0软件分析，综合评价青蒿琥酯与阿奇霉素伍用的疗效。结果：间日疟A组（青蒿琥酯与阿奇霉素）共52例，服药前平均体温38.50.11℃，平均原虫密度5320个/ul。完成全疗程治疗（3天）52例，有效52例，有效率100%；完成7d临床观察51例（1例退出），平均退热时间31.691.73h，平均原虫转阴时间30.311.71h。临床治愈率100%，，282d根治率78.3%(36/46)，602d根治率70.7%(29/41)，902d根治率68.4%(26/38)。间日疟B组(标准的氯伯8d疗法)共39例，服药前平均体温38.90.13℃，平均原虫密度4507个/ul。完成全疗程治疗（氯喹片3天，伯氨喹8天）39例，有效39例，有效率100%，平均退热时间32.42.02h，平均原虫转阴时间30.821.98h，临床治愈39例，临床治愈率100%。282d根治率97.4%(38/39)，602d根2014届硕士学位论文青蒿琥酯与阿奇霉素伍用治疗疟疾的临床研究治率89.7%(35/39)，902d根治率87.2%(34/39)。A、B组间比较平均退热时间、原虫转阴时间，差异无统计学意义（P＞0.01）。A、B组间比较282d、602d、902d，差异有统计学意义（P0.05）。恶性疟C组（青蒿琥酯与阿奇霉素）共23例，服药前平均体温39.00.19℃；平均原虫密度19462个/ul。完成全疗程治疗（青蒿琥酯与阿奇霉素伍用3天）23例，有效率95.7%（22/23），平均退热时间42.573.74h；平均原虫转阴时间41.133.63h，完成28天随访的20例中13例治愈，治愈率65%（13/20）。恶性疟D组(双氢青蒿素哌喹)共22例，服药前平均体温38.60.2℃；平均原虫密度14923个/ul。完成全疗程治疗22例，有效率100%；平均退热时间37.094.67h；原虫转阴时间35.554.66h。完成28天随访的17例中全部治愈，治愈率100%。 C、D组间比较平均退热时间、原虫转阴时间，差异无统计学意义（P＞0.01）。C、D组间比较28天治愈率差异有统计学意义（P0.05）。4组病人对药物均有较好的耐受性,个别病人在服药过程中出现腹泻、恶心、腹痛等症状,均较轻微且有自限性。结论： 1.标准的氯/伯喹8d疗法治疗当地间日疟是安全有效的，3个月的根治率为87.1%；与标准的间日疟疗法比较，青蒿琥酯与阿奇霉素伍用治疗间日疟有速效和不良反应少等优点，但对间日疟的根治率不如前者。 2.标准的双氢青蒿素哌喹片疗法治疗当地恶性疟是安全有效的，28d治愈率100%；青蒿琥酯与阿奇霉素伍用治疗恶性疟近期疗效和不良反应二者相似，但治愈率不如前者。
[Abstract]:Objective:
1. the efficacy of artesunate and azithromycin in the treatment of malaria was observed.
2. the efficacy of the standard treatment of Plasmodium vivax (falciparum malaria) in the treatment of Plasmodium vivax (falciparum malaria) was observed.
3 compared with the standard Plasmodium vivax and the treatment of malarial malaria, the efficacy of artesunate and azithromycin in the treatment of malaria was evaluated.
Methods: in the western region of Yunnan province and Ruili border in Laiza Nongdao town set up two observation points, mainly to observe the effect of artesunate and Azithromycin combined with function of killing human blood stage Plasmodium. The smear were single infection of Plasmodium falciparum or vivax malaria patients strictly according to the screening conditions selected. Group A (vivax malaria artesunate and azithromycin in the observation group) and group B (primary 8D chlorine standard therapy as the control group); group C (falciparum artesunate and azithromycin in the observation group) and group D (standard dihydroartemisinin piperaquine therapy as the control group). According to the sequence of 1:1 random number in the patient group, A group and C group was treated with artesunate and Azithromycin combined with 3D treatment, B group with Chloroquine Phosphate Tablets 3D primaquine phosphate 8 days of treatment, group D with Dihydroartemisinin and Piperaquine Phosphate Tablets 3D in the treatment of vivax malaria. After administration of 24h, 48h, observation / counting Plasmodium reduced rate, 1 weeks of treatment The rate of cure rate, continuous observation of 3 months, and observe the patient body temperature returned to normal time; falciparum malaria were observed after 24h, 48h, observation / counting Plasmodium reduction rate of 1 weeks, the clinical cure rate, the cure rate of 28d. The results were analyzed by SPSS16.0 software, a comprehensive evaluation of efficacy of artesunate and Azithromycin combined with the.
Results: A group (vivax artesunate and azithromycin) a total of 52 cases, before taking the average temperature of 38.50.11 DEG C, the mean parasite density of 5320 /ul. completed the treatment course (3 days) in 52 cases, effective 52 cases, efficiency of 100%; the completion of 7D clinical observation of 51 cases (1 cases, the average cooling time of 31.691.73h exit). The mean parasite clearance time 30.311.71h. clinical cure rate was 100%, the cure rate of 282D 78.3% (36/46), the cure rate of 602d 70.7% (29/41), the cure rate of 902d 68.4% (26/38). Group B (primary vivax chloride standard therapy for 8D) a total of 39 cases, before taking the average temperature of 38.90.13 DEG C, the mean parasite density 4507 /ul. complete the whole treatment (chloroquine primaquine for 3 days, 8 days) in 39 cases, 39 cases were effective, the efficiency is 100%, the average cooling time 32.42.02h, the mean parasite clearance time of 30.821.98h, 39 cases were cured, the cure rate of clinical cure rate of 100%.282d 97.4% (38/39), 602d root 2014 master's degree thesis and artesunate Azithromycin in the treatment of malaria was 89.7% (35/39), the cure rate of 902d was 87.2% (34/39).A, the average fever time of B group, and the time of protozoan conversion were not statistically significant (P > 0.01).A, B group comparison 282D, 602d, 902d, the difference was statistically significant (P0.05).
Plasmodium falciparum C group (artesunate and azithromycin) a total of 23 cases, before taking the average temperature of 39.00.19 DEG C; the mean parasite density of 19462 /ul. finished the whole treatment (artesunate and Azithromycin combined with 3 days) in 23 cases, efficiency of 95.7% (22/23), the average cooling time of 42.573.74h; the mean parasite clearance time 41.133.63h, complete 28 days of follow-up in 20 cases 13 cases were cured, the cure rate was 65% (13/20). Group D (falciparum dihydroartemisinin piperaquine) a total of 22 cases, before taking the average temperature of 38.60.2 DEG C; the mean parasite density of 14923 /ul. finished the whole treatment in 22 cases, the effective rate was 100%; the average cooling time 37.094.67h; parasite clearance time 35.554.66h. 28 days of follow-up of 17 cases were cured, the cure rate of 100%., C, D group compared to the average defervescence time, parasite clearance time, there was no statistically significant difference (P > 0.01).C, D between two groups 28 day cure rate difference was statistically significant (P0.05.4) The patients in the group had better tolerance to the drugs. Some patients had symptoms such as diarrhea, nausea and abdominal pain in the course of taking medicine, all of which were mild and self limiting.
Conclusion:
1. standard chlorine / primaquine 8D therapy in the treatment of local vivax malaria is safe and effective, 3 months of the cure rate was 87.1%; compared with the standard treatment of vivax malaria, artesunate and Azithromycin combined treatment of vivax malaria has the advantages of quick and adverse reactions, but the vivax malaria cure rate is not as the former.
The 2. standard Dihydroartemisinin and Piperaquine Phosphate Tablets therapy is safe and effective for the treatment of local falciparum malaria. The cure rate of 28d is 100%. The artemisinin and azithromycin are similar in treating two cases, but the cure rate is not as good as the former.

【学位授予单位】：大理学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R531.3

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