两性霉素B胆固醇硫酸酯复合物治疗AIDS合并马尔尼菲篮状菌病的疗效及其致急性肾损伤的危险因素

Effect of amphotericin B cholesteryl sulfate complex on treatment of patients with acquired immunodeficiency syndrome–associated Talaromycosis marneffei and risk factors for acute kidney injury

    摘要
  • 摘要:
    目的 探讨两性霉素B胆固醇硫酸酯复合物（ABCD）与普通两性霉素B（AmB）在艾滋病（AIDS）合并马尔尼菲篮状菌病（TSM）患者中的安全性，分析ABCD致急性肾损伤（AKI）的危险因素。
    方法 纳入2023年10月－2025年1月昆明市第三人民医院收治的160例AIDS合并TSM患者，随机分为ABCD组和AmB组各80例。收集两组患者的临床资料，评估抗真菌治疗的疗效及安全性。采用多因素logistic回归分析筛选AIDS合并马尔尼菲篮状菌病患者使用ABCD发生AKI的危险因素。
    结果 ABCD与AmB治疗AIDS合并TSM的总有效率差异无统计学意义（P=0.693）；ABCD组总体不良事件发生率低于AmB组（P=0.008），ABCD组的低钾血症、急性肾损伤、骨髓抑制发生率低于对照组（P＜0.05），其中ABCD组血钾下降幅度较低（P＜0.05）；ABCD组AKI发生率（35.00%）低于AmB（60.00%）组（P=0.002），且AKI发生时间延迟（P=0.018）。高血压/糖尿病（OR=6.174）、联用肾毒性药物（OR=5.625）及ABCD剂量＞4 mg/（kg•d−1）（OR=5.108）和尿素氨升高（OR=1.690）是AIDS合并马尔尼菲篮状菌病患者使用ABCD发生AKI的危险因素（P＜0.05）。
    结论 在AIDS合并TSM治疗中，ABCD与AmB的总有效率相当，但ABCD较AmB具有更好的安全性，并可降低AKI和严重低钾血症风险，整体耐受性更优。对合并代谢性疾病、需联用肾毒性药物或接受高剂量ABCD＞4 mg/（kg•d−1）治疗的高风险人群，应制定个体化治疗策略，建立风险预警体系。

     

    Abstract:
    OBJECTIVE  To investigate the safety of amphotericin B cholesteryl sulfate complex （ABCD） and conventional amphotericin B （AmB） in patients with acquired immunodeficiency syndrome （AIDS） complicated by Talaromycosis marneffei （TSM）, and to analyze the risk factors for acute kidney injury （AKI） induced by ABCD.
    METHODS  A total of 160 patients with AIDS complicated by TSM admitted to the Third People's Hospital of Kunming from Oct. 2023 to Jan. 2025 were enrolled and randomly divided into the ABCD group （n=80） and the AmB group （n=80）. Clinical data of the two groups were collected to evaluate the efficacy and safety of antifungal therapy. Multivariate logistic regression analysis was employed to screen for risk factors for AKI in patients with AIDS complicated by TSM treated with ABCD.
    RESULTS  No statistically significant difference was observed in the overall effective rate between the ABCD and the AmB in the treatment of AIDS complicated by TSM （P=0.693）. The overall incidence of adverse events in the ABCD group was lower than that in the AmB group （P=0.008）. The incidences of hypokalemia, AKI and myelosuppression in the ABCD group were lower than those in the control group （P＜0.05）. Among them, the decrease in serum potassium level in the ABCD group was relatively small （P＜0.05）. The incidence of AKI in the ABCD group （35.00%） was lower than that in the AmB group （60.00%） （P=0.002）, and the onset time of AKI was delayed （P=0.018）. Comorbid hypertension/diabetes （OR=6.174）, concurrent use of nephrotoxic drugs （OR=5.625） and an ABCD dose ＞4 mg/（kg•d−1） （OR=5.108） and elevated BUN levels （OR=1.690） were risk factors for AKI in patients with AIDS complicated by TSM treated with ABCD.
    CONCLUSIONS  In the treatment of AIDS complicated with TSM, ABCD and AmB have comparable total effective rates. However, ABCD exhibits better safety, reduces the risks of AKI and severe hypokalemia, demonstrating superior overall tolerability compared to AmB. For high-risk populations, including those with concurrent metabolic diseases, those requiring combination therapy with nephrotoxic drugs or those receiving high-dose ABCD ＞4 mg/（kg•d−1） treatment, individualized treatment strategies should be formulated, and a risk early warning system should be established.

     

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