中国药物警戒 ›› 2021, Vol. 18 ›› Issue (1): 38-42.
DOI: 10.19803/j.1672-8629.2021.01.07

• 基础与临床研究 • 上一篇    下一篇

膦甲酸钠与更昔洛韦治疗获得性免疫缺陷综合征相关巨细胞病毒感染的安全性比较

薛晓拉1, 夏玉朝1, 李超峰2, 陈媛媛2,*   

  1. 1郑州市第六人民医院药学部,河南 郑州 450015;
    2郑州市第六人民医院感染科,河南 郑州 450015
  • 收稿日期:2020-05-06 修回日期:2021-01-18 出版日期:2021-01-15 发布日期:2021-01-18
  • 通讯作者: *陈媛媛,女,硕士,副主任医师,艾滋病临床诊疗研究。E-mail:cyy1805@126.com
  • 作者简介:薛晓拉,女,硕士,临床药师,合理用药。
  • 基金资助:
    国家“十三五”科技重大专项(2017ZX10202101-001-010):艾滋病综合治疗方案的优化及推广应用研究

Safety Comparison of Foscarnet and Ganciclovir in the Treatment of Cytomegalovirus Infection with AIDS

XUE Xiaola1, XIA Yuchao1, LI Chaofeng2, CHEN Yuanyuan2,*   

  1. 1Department of Pharmacy,the Sixth People's Hospital of Zhengzhou,Zhengzhou Henan 450015,China;
    2Department of Infectious Diseases,the Sixth People's Hospital of Zhengzhou,Zhengzhou Henan 450015,China
  • Received:2020-05-06 Revised:2021-01-18 Online:2021-01-15 Published:2021-01-18

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摘要： 目的 比较膦甲酸钠与更昔洛韦治疗获得性免疫缺陷综合征(AIDS)合并巨细胞病毒(CMV)感染的安全性,为临床安全合理用药提供参考。方法 将315例AIDS合并CMV感染患者分为膦甲酸钠组(155例)和更昔洛韦组(160例),治疗后比较其安全性。结果 膦甲酸钠可引起局部麻木、抽搐及电解质异常,更昔洛韦常致骨髓抑制及胃肠道反应。膦甲酸钠组药品不良反应(ADR)发生率(45.15%)低于更昔洛韦组(72.50%),组间差异有统计学意义(P<0.05);膦甲酸钠组44.28%的患者因ADR停药,9.68%的患者更换为更昔洛韦继续治疗。更昔洛韦组64.66%的患者因ADR停药,24.38%的患者更换为膦甲酸钠继续治疗。两组间因ADR停药及更换治疗方案间差异有统计学意义(P<0.05)。ADR发生后,及时停药或对症处理,无严重后遗症或死亡病例发生。结论 膦甲酸钠的安全性优于更昔洛韦。AIDS患者抗CMV感染选择药物时,可根据膦甲酸钠与更昔洛韦所致ADR的临床表现,避免选择与正在使用药物有相同ADR的药物,以减少ADR的叠加。膦甲酸钠的ADR发生率、ADR发生后的停药比例及更换治疗方案比例均小于更昔洛韦,患者不能耐受更昔洛韦时,可使用膦甲酸钠作为替代治疗。

关键词: 获得性免疫缺陷综合征, 巨细胞病毒感染, 膦甲酸钠, 更昔洛韦, 安全性

Abstract: Objective To compare the safety of foscarnet and ganciclovir in the treatment of cytomegalovirus in patients with AIDS so as to provide reference for safe and rational use of drugs.Methods A total of 315 cytomegalovirus infection patients with AIDS treated with foscarnet or ganciclovir between January 2018 and January 2019 were collected,who were divided into the foscarnet group(n=155) and the ganciclovir group(n=160).Safety was evaluated after treatment.Results Foscarnet could induce regional numbness,twitch and abnormalities of electrolytes,while ganciclovir often led to myelosuppression and gastrointestinal reactions.The incidence of adverse reactions (ADR) in the foscarnet group(45.155) was statistically lower than in the ganciclovir group(72.50%).The withdrawal rate of foscarnet due to ADRs was 44.28%,compared with 64.66% for ganciclovir.The ganciclovir group was more likely to switch to an alternative treatment.After withdrawal of foscarnet or ganciclovir and symptomatic treatment,most of the symptoms disappeared and no serious sequelae or death occurred.Conclusion Foscarnet is safer than ganciclovir.According to the clinical manifestations of adverse reactions caused by foscarnet or ganciclovir,drugs that are likely to cause the same adverse reactions as the drugs being used should not be used to reduce the superposition of adverse reactions when AIDS patients are CMV infected.The incidence of ADRs,the withdrawal rate of foscarnet due to ADRs and the proportion of cases of switch to an alternative treatment in the foscarnet group are all lower than in the ganciclovir group,so foscarnet can be considered once ganciclovir is not tolerated.

Key words: AIDS, cytomegalovirus infection, foscarnet, ganciclovir, safety evaluation

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