目的 探讨两性霉素B(AMB)椎管内持续给药治疗新型隐球菌性脑膜炎的脑脊液药代动力学特点.方法 对3例新型隐球菌性脑膜炎患者进行了AMB椎管内持续给药疗法,用高效液相色谱法(HPLC)对其脑脊液(CSF)中AMB的药物浓度进行连续测定.结果 AMB椎管内持续给药后脑脊液中AMB的药物浓度大于AMB对新型隐球菌的最低抑菌浓度(MIC).药-时曲线显示在开始进行AMB椎管内持续给药当天以及每次药物加量当天的AMB在CSF中的药物浓度出现较大波动,第2天处于稳定水平,AMB在CSF中的药物浓度维持在0.61～1.21 μg/ml.结论 椎管内持续给药能显著提高脑脊液中AMB浓度,而且能维持稳定有效的药物浓度,从而达到有效治疗的目的.%Objective To explore the pharmacokinetics of amphoteridn B (AMB) in the cerebrospinal fluid (CSF) during continuous intrathecal administration of AMB for treatment of cryptococcal neoformans meningitis (CNM). Methods The concentration of AMB in the CSF was measured using reversed phase high performance liquid chromatography (RP-HPLC) in 3 patients receiving continuous intrathecal infusion of AMB for CNM. Results AMB concentrations in the CSF of the 3 patients exceeded the minimal inhibitory concentration (MIC) of AMB against Cryptococcus neoformans. The concentration-time curve showed that AMB concentration in the CSF underwent obvious variations on the first day of intrathecal infusion and after additional AMB doses, but maintained a stable level (0.61-1.21 μg/ml) on the next day. Conclution Continuous intrathecal administration of AMB can enhance the drug concentration in the CSF and maintain a stable and effective drug level for treatment of CNM.
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