单纯口服伊曲康唑与合用两性霉素B滴眼液治疗真菌性角膜炎的疗效比较

发布时间：2018-06-11 21:18

本文选题：伊曲康唑 + 两性霉素B　；参考：《浙江大学》2010年硕士论文

【摘要】： 目的：观察和比较单纯口服伊曲康唑与合用两性霉素B滴眼液治疗真菌性角膜炎的疗效。方法：研究对象为2006年10月至2008年9月在我院诊治的病原培养阳性的真菌性角膜炎病例。将病人根据病例号数字的奇偶性随机分为A、B两组,A组予以口服伊曲康唑胶囊(300mg／d),B组予以口服伊曲康唑联合0.15％两性霉素B滴眼液(每30min 1次)。如药物治疗1周病情加重,更改治疗方案(加用药物或介入手术),每周随访1次。根据疾病轻、中、重症和不同致病菌分类,比较1周后两组采用初始药物方案治疗后出现对药物有效反应的病例数,以及采用初始药物治疗方案达到清除感染的病例数及治疗时间。结果：纳入该研究的真菌性角膜炎病例共100例,A组48例,B组52例。A组中轻、中、重症病例分别为13例(27％)、18例(38％)和17例(35％),B组为13例(25％)、17例(33％)和22例(42％),两组的轻、中和重症病例差异无统计学意义(P0.05)。经初始药物方案治疗1周后,A、B两组出现药物有效反应的病例分别为24例(50％)和38例(73％),差异有统计学意义(P=0.018)。采用初始治疗方案达到清除感染的病例：A组25例(52％),B组40例(77％),其中,轻症病例：两组的初始药物治愈率分别为92％和77％,差异无统计学意义(P0.05)；中症病例：两组的初始药物治愈率分别为50％和82％,差异有统计学意义(P=0.044)；重症病例：两组的初始药物治愈率分别为24％和73％,差异有统计学意义(P=0.002)。采用初始治疗方案治疗达到清除感染的时间：A组中轻、中和重症病例的平均治疗时间分别为29天、50天和70天；B组中轻、中和重症病例的平均治疗时间分别为17天、30天和64天,其中轻、中症病例的平均治疗时间差异有统计学意义(轻度：P=0.026；中度：P=0.007)。结论：对于轻症真菌性角膜炎,采用单独口服伊曲康唑或联合使用两性霉素B滴眼液,大部分病例可达到清除感染的目的。对于中或重症病例,口服伊曲康唑联合两性霉素B滴眼液的疗效优于单独口服伊曲康唑。
[Abstract]:Objective: to observe and compare the efficacy of oral itraconazole and amphotericin B eye drops in the treatment of fungal keratitis. Cases of bacterial keratitis. Patients were randomly divided into two groups according to the number of cases. Group A was given orally itraconazole capsule 300 mg / d and group B was given orally itraconazole combined with 0.15% amphotericin B eye drops (once per 30min). If the condition gets worse after 1 week of medication, change the treatment regimen (add medicine or interventional surgery, follow up once a week. According to the classification of mild, moderate, severe and different pathogenic bacteria, the number of patients in the two groups who appeared effective response to the drug after the initial drug regimen was compared one week later. Results: 100 cases of fungal keratitis were included in this study. There were 48 cases in group A and 52 cases in group B. There were 13 severe cases (18 cases) and 17 cases (group B, 13 cases) and 22 cases (42 cases). There was no significant difference in light, moderate and severe cases between the two groups (P 0.05). After one week of initial drug therapy, the effective drug response was found in 24 cases (50 cases) and 38 cases (73 cases) in the two groups respectively. The difference was statistically significant (P = 0.018). There were 25 cases in group A, 25 cases in group A, 40 cases in group B, and 77 cases in group B, among which, Mild cases: the initial drug cure rates of the two groups were 92% and 77% respectively, the difference was not statistically significant (P 0.05); the initial cure rate of the two groups was 50% and 82% respectively, the difference was statistically significant (P 0.044); severe cases: the initial cure rate of the two groups was 0. 044%. The cure rate of drug was 24% and 73% respectively, the difference was statistically significant. The average treatment time of initial treatment regimen was 29 days, 50 days and 70 days respectively, and the average treatment time was 17 days, 30 days and 64 days, respectively, in group A, and in group B, the average time of treatment was 29 days, 50 days and 70 days, respectively, and the average treatment time of group B was 17 days, 30 days and 64 days, respectively. There was significant difference in the average treatment time between mild and moderate cases (mild: P0.026; moderate: P0. 007. Conclusion: for mild fungal keratitis, itraconazole alone or amphotericin B eye drops were used alone. Most cases can achieve the goal of eliminating infection. For moderate or severe cases, the efficacy of oral itraconazole combined with amphotericin B eye drops was better than that of itraconazole alone.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R772.21

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