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两性霉素B的肾毒性

Author
Richard H Sterns, MD
Section Editor
Michael Emmett, MD
Deputy Editor
John P Forman, MD, MSc
Translators
尹广, 主任医师，教授

引言

两性霉素B用于治疗常常危及生命的真菌感染。(参见“两性霉素B的药理学”)肾功能损害是两性霉素B相对常见的并发症，此外还有其他肾脏表现，包括：尿钾消耗及低钾血症、尿镁消耗及低镁血症、Ⅰ型(或远端)肾小管酸中毒(renal tubular acidosis, RTA)所致的代谢性酸中毒，以及肾性尿崩症所致的多尿[1-5]。

两性霉素B肾毒性的概述见此专题。低钾血症、低镁血症、远端RTA及肾性尿崩症的治疗将在别处详细讨论。 (参见“成人低钾血症的临床表现和治疗”，关于‘治疗’一节和“低镁血症的评估和治疗”，关于‘治疗’一节和“远端(Ⅰ型)和近端(Ⅱ型)肾小管性酸中毒的治疗”，关于‘远端(Ⅰ型)RTA’一节和“肾性尿崩症的治疗”)

急性肾损伤

传统两性霉素B所致的发病率 — 传统的两性霉素B(即，非脂质剂型)可引起肾血管收缩，并且可使肾小球滤过率(glomerular filtration rate, GFR)降低50%以上[1-4,6,7]。两项最大型的回顾性研究中，494例和643例患者分别有138例(28%)和174例(27%)的血清肌酐值升高50%或以上[4,6]。

还有其他因素可影响两性霉素诱导的肾损伤的风险：

●联合应用其他肾毒性药物，如氨基糖苷类抗生素、环孢素或膦甲酸，可增加急性肾损伤的风险[4,6-8]。一篇报道显示，不联用或仅联用1种其他肾毒性药物的患者中，血清肌酐值升高至2倍或以上的发生率为15%，而与两种或两种以上其他肾毒性药物联用的患者中，该发生率为41%[7]。

       

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-03.
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