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HIV 阴性播散型马尔尼菲篮状菌骨髓炎合并肺结核患者的药学

监护
Δ

张清华 ，何丽庭（江门市中心医院药学部，广东 江门 529000）
＊

中图分类号 S945.1+3；R969.3 文献标志码 A 文章编号 1001-0408（2025）16-2062-05
DOI 10.6039/j.issn.1001-0408.2025.16.19

摘 要 目的 为人类免疫缺陷病毒（HIV）阴性患者播散型马尔尼菲篮状菌（TM）骨髓炎合并肺结核抗感染治疗的药学监护提供
参考。方法 临床药师参与1例HIV阴性播散型TM骨髓炎合并肺结核患者的治疗全过程，系统评估患者临床症状、体征及检验、
影像学结果后，协助医师制定治疗方案及完善诊断，建议给予两性霉素B胆固醇硫酸酯复合物抗真菌治疗和完善结核菌素试验及
痰涂片抗酸染色，实时监护患者的临床表现及检验结果；及时发现患者血钾降低，分析原因后，先后建议口服和静脉补钾，并调整
治疗方案（改用伊曲康唑，联合异烟肼+利福平+吡嗪酰胺+乙胺丁醇四联抗结核），同时建议监测伊曲康唑血药浓度。此外，临床
药师还对患者进行了系统的用药和健康教育。结果 医师采纳临床药师的建议，患者治疗后好转出院。临床药师随访1年患者病
情治愈，无不良反应发生。结论 两性霉素B胆固醇硫酸酯复合物是HIV阴性患者播散型TM骨髓炎的有效治疗药物，延长疗程
可防止复发；用药期间临床药师需加强药学监护，保障患者用药安全。
关键词 马尔尼菲篮状菌；两性霉素B胆固醇硫酸酯复合物；化脓性骨髓炎；肺结核；药学监护

Pharmaceutical care for the HIV-negative patient with disseminated Talaromyces marneffei osteomyelitis
complicated by pulmonary tuberculosis
ZHANG Qinghua，HE Liting（Dept. of Pharmacy， Jiangmen Central Hospital， Guangdong Jiangmen 529000，
China）

ABSTRACT OBJECTIVE To provide references for pharmaceutical care in the anti-infective treatment of disseminated
Talaromyces marneffei （TM）osteomyelitis complicated with pulmonary tuberculosis in a human immunodeficiency virus
（HIV）-negative patient. METHODS Clinical pharmacists participated in the entire treatment process of a HIV-negative patient with
disseminated TM osteomyelitis complicated by pulmonary tuberculosis. The pharmacist assisted the clinician in formulating an
individualized treatment plan and improving the diagnosis based on the patient’s clinical symptoms， signs， laboratory tests， and
imaging findings. Recommendations included the use of amphotericin B cholesteryl sulfate complex for antifungal therapy， the
completion of a tuberculin skin test and sputum acid-fast bacilli test. The pharmacist monitored the patient’s clinical manifestations
and laboratory results in real time. Upon timely detection of hypokalemia in the patient， after analyzing the causes， oral and then
intravenous potassium supplementation was sequentially recommended， along with adjustments to the treatment plan （switching to
itraconazole and combining it with a four-drug antituberculosis regimen of isoniazid+rifampicin+pyrazinamide+ethambutol）.
Meanwhile， monitoring of itraconazole blood concentration was also advised. Additionally， the clinical pharmacist closely
monitored the patient’s medication adherence and provided medication education. RESULTS The clinicians accepted the clinical
pharmacist’s recommendations. The patient improved after treatment and was discharged. One-year follow-up showed that the
patient was cured without adverse reactions. CONCLUSIONS Amphotericin B cholesteryl sulfate complex is an effective
therapeutic agent for disseminated TM osteomyelitis in HIV-negative patients. Prolonging the course of treatment can prevent
recurrence. During therapy， clinical pharmacists should strengthen pharmaceutical care as well as provide medication and health
education to ensure patient safety.
KEYWORDS Talaromyces marneffei； amphotericin B cholesteryl sulfate complex； suppurative osteomyelitis； pulmonary
tuberculosis； pharmaceutical care
Δ 基金项目 广东省医学科研基金（No.B2025668）；江门市医疗卫 马尔尼菲篮状菌（Talaromyces marneffei，TM）病是
生领域科技计划项目（No.2024YL01091）
[1]
由双相型真菌 TM 引起的一种侵袭性真菌病 ，主要流
＊第一作者 主管药师，硕士。研究方向：临床药学和个体化药物
治疗。E-mail：Tsinghua1010@126.com 行于泰国、马来西亚、新加坡和我国台湾、香港及部分大

· 2062 · China Pharmacy 2025 Vol. 36 No. 16 中国药房 2025年第36卷第16期