艾滋病合并结核性脑膜炎患者不同剂量利福平治疗方案的真实世界研究

doi:10.19871/j.cnki.xfcrbzz.2025.01.006

摘要/Abstract

摘要： 目的探究艾滋病合并结核性脑膜炎（tuberculous meningitis,TBM）患者使用不同剂量利福平治疗的疗效和安全性。方法回顾性分析重庆市公共卫生医疗救治中心2018年1月至2022年12月收治的246例艾滋病合并结核性脑膜炎患者的临床资料,按照每日静脉使用利福平剂量分为600mg利福平（600mg R）组和450mg利福平（450mg R）组,对比分析不同组别患者疗效及不良反应发生情况。结果纳入246例患者中,使用600mg R组206例,450mg R组40例。两组患者基线情况无统计学差异。两组患者经治疗出院时,600mg R组患者意识障碍发生率（10.4%）明显低于450mg R组患者（21.5%）,差异有统计学意义（P<0.05）;600mg R组患者脑脊液总蛋白较450mg R组患者下降更明显,差异有统计学意义（P<0.05）。600mg R组患者好转率[78.7%（162/206）]高于450mg R组患者[60.0%（24/40）],非好转率[18.9%（39/206)]及病死率[2.4%（5/206）]均低于450mg R组患者[分别为32.5%（13/40）和7.5%（3/40）],差异有统计学意义（P<0.05）。结论使用较高剂量利福平（600mg/d）可以提高艾滋病合并结核性脑膜炎患者的治疗效果。

关键词: 艾滋病, 结核性脑膜炎, 利福平, 治疗剂量

Abstract: Objective To explore the efficacy and safety of different doses of rifampicin in AIDS patients with tuberculous meningitis (TBM). Method The clinical data of 246 AIDS patients with tuberculous meningitis (AIDS/TBM) admitted to Chongqing Public Health Medical Treatment Center from January 2018 to December 2022 were retrospectively analyzed. The patients were divided into the 600mg R group and the 450mg R group according to the daily intravenous dose of rifampicin, and the differences in the treatment effect and adverse reactions of patients in different groups were compared and analyzed. Result Among the 246 patients included, 206 were in the 600mg rifampicin group (600mg R) and 40 were in the 450mg rifampicin group (450mg R) treated with rifampicin. There was no significant statistical difference in baseline conditions between the two groups of patients. When the two groups of patients were discharged after treatment, the incidence of consciousness disorders in patients of the 600mg R group (10.4%) was significantly lower than that in patients of the 450mg R group (21.5%), and the difference was statistically significant（P<0.05）. The total protein in cerebrospinal fluid of patients win the 600mg R group decreased more significantly than that of patients in the 450mg R group, and the difference was statistically significant（P<0.05）. The improvement rate (162/206, 78.7%) of patients in the 600mg R group was higher than that in the 450mg R group (24/40, 60%), while the non-improvement rate (39/206, 18.9%) and mortality rate (5/206, 2.4%) were lower than those in the 450mg R group (13/40, 32.5% and 3/40, 7.5%, respectively), with statistical significance (P<0.05). Conclusion The use of a higher dose of rifampicin (600mg/d) can improve the treatment effect of AIDS patients with tuberculous meningitis compared with 450mg/d rifampicin.

Key words: Acquired immune deficiency syndrome, Tuberculous meningitis, Rifampicin, Therapeutic dose

中图分类号:

R529.3

吴玉珊, 张绿浪, 黄锐, 李梅, 张声恋, 林润英, 刘敏. 艾滋病合并结核性脑膜炎患者不同剂量利福平治疗方案的真实世界研究[J]. 新发传染病电子杂志, 2025, 10(1): 27-31.

Wu Yushan, Zhang Lyulang, Huang Rui, Li Mei, Zhang Shenglian, Lin Runying, Liu Min. The real world study of different doses of rifampicin in AIDS patients with tuberculous meningitis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(1): 27-31.

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