Saliba Faouzi, Dupont Bertrand
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud, Villejuif, France.
Med Mycol. 2008 Mar;46(2):97-112. doi: 10.1080/13693780701730469.
A systematic review was performed to examine renal function in patients with invasive fungal infections, comparing the nephrotoxicity caused by conventional amphotericin B deoxycholate (c-AmB) with that induced by the use of lipid-based amphotericin B formulations. The analysis considered all comparative studies published in the literature between January 1996 and May 2007. The outcome data reviewed herein focused on renal toxicity as measured by serum creatinine (S-Cr) and the doubling or the mean difference in S-Cr levels from baseline to the end of therapy or the need for dialysis. We found that AmB lipid complex (ABLC), liposomal AmB (L-AmB) and AmB colloidal dispersion (ABCD) were significantly less nephrotoxic than c-AmB in all reported studies. ABLC and L-AmB caused low and comparable nephrotoxicity in nine studies. In one randomized study, L-AmB was significantly less nephrotoxic than ABLC. No studies compared ABCD nephrotoxicity to the other lipid formulations. Based on our review we conclude that lipid formulations of amphotericin B are an important strategy to preserve renal function and improve survival in critically ill patients who require treatment for systemic fungal infections.
进行了一项系统评价，以研究侵袭性真菌感染患者的肾功能，比较传统的两性霉素B脱氧胆酸盐（c-AmB）与基于脂质的两性霉素B制剂所引起的肾毒性。该分析纳入了1996年1月至2007年5月间发表在文献中的所有比较研究。本文回顾的结局数据集中于以血清肌酐（S-Cr）衡量的肾毒性，以及从基线到治疗结束时S-Cr水平的翻倍或平均差异，或透析需求。我们发现在所有已报道的研究中，两性霉素B脂质复合物（ABLC）、脂质体两性霉素B（L-AmB）和两性霉素B胶体分散体（ABCD）的肾毒性均显著低于c-AmB。在9项研究中，ABLC和L-AmB引起的肾毒性较低且相当。在一项随机研究中，L-AmB的肾毒性显著低于ABLC。没有研究将ABCD的肾毒性与其他脂质制剂进行比较。基于我们的综述，我们得出结论，两性霉素B的脂质制剂是保护肾功能和提高需要全身性真菌感染治疗的重症患者生存率的重要策略。
