艾滋病并发马尔尼菲篮状菌的体外药敏试验分析

Analysis of in Vitro Drug Dusceptibility Test in AIDS Patients Coinfected with Talaromyces marneffei

摘要: 目的：分析艾滋病(AIDS)合并马尔尼菲篮状菌(TM)感染的体外药敏试验结果及临床治疗效果，为临床合理用药提供依据。方法：收集2016年2月至2018年11月云南省某医院收治的119例AIDS并发TM感染患者的临床病历资料，分析患者的人口学特征、标本类型、TM体外药敏试验结果及临床治疗效果。结果：119例病人中，男性患者是女性的2.61倍。平均年龄为37.08岁，年龄区间3~70岁，以青壮年居多。检出标本类型最多，为血液和骨髓，共105人，占总样本数的88.24%。CD4⁺T淋巴细胞计数为39 ± 40 cells/μl，大多数患者处于艾滋病晚期。两性霉素B、伊曲康唑和伏立康唑对马尔尼菲篮状菌的敏感性均为100%。119例患者中有8例未接受抗真菌治疗患者均死亡，111例接受了抗真菌治疗，其中105例治疗好转，治疗好转率94.59% (105/111)。两性霉素B治疗组和伏立康唑治疗组好转率比较差异无统计学意义(P = 0.317, χ² = 0.859)。结论：AIDS合并TM感染好发于CD4⁺T淋巴细胞计数低于50 cells/μl的患者，临床表现复杂多样。云南省艾滋病并发马尔尼菲篮状菌病推荐选择两性霉素B、伏立康唑和伊曲康唑治疗，尽量避免使用氟康唑和氟胞嘧啶。

Abstract: Objective: To analyze in vitro drug susceptibility test and clinical treatment effect of AIDS coinfected with Talaromycosis, and to provide the basis for clinical rational drug use. Methods: The clinical medical records of 119 patients infected with both AIDS and Talaromyces marneffei were collected from February 2016 to November 2018 at a hospital in Yunnan province. The demographic characteristics, specimen types, the results of drug susceptibility test in vitro and clinical treatment effect were retrospectively analyzed. Results: Among the 119 patients, men were 2.61 times likely than women. The average age was 37.08 years old, and the age range from 3 to 70 years old. Most of them were young adults. Blood and bone marrow were the most common samples, accounting for 88.24% of the total samples. The mean CD4⁺T lymphocyte count was 39 ± 40 cells/μl, and most patients are in advanced stages of AIDS. Amphotericin B, Itraconazole and Voriconazole were all 100% sensitive to Talarmoyces marneffei. Among the 119 patients,8 patients who did not receive antifungal therapy all died, and 111 patients who received antifungal therapy, among which 105 patients got better treatment and the treatment improvement rate was 94.59% (105/111). There was no significant difference in improvement rate between amphotericin B treatment group and Voriconazole treatment group (P = 0.317, χ² = 0.859). Conclusion: A mixed infection of AIDS and T. marneffei develops in patients with a CD4⁺T lymphocyte count below 50 cells/μl, and its clinical manifestations are complex and diverse. It is recommended to choose amphotericin B, Voriconazole and itraconazole for treatment of AIDS combined with Talaromycosis, and fluconazole and flucytosine shoule be avoided as far as possible in Yunnan.