摘要
目的探讨临床上常用抗真菌药物在恶性血液病合并侵袭性真菌病(IFD)患者中的总体疗效、分层诊断疗效、疗效与感染部位的关系以及常见毒副反应。方法回顾性分析2005年1月至2008年8月在中山大学附属第一医院住院的117例恶性血液病合并IFD患者的临床资料。结果伊曲康唑、伏立康唑、卡泊芬净和脂质体两性霉素B治疗的总有效率分别为69.0%(40/58)、77.4%(24/31)、64.7%(11/17)和63.6%(7/11)(P=0.726);肺部感染患者中,4种药物的有效率分别为63.0%(17/27)、85.7%(12/14)、50.0%(4/8)和62.5%(5/8)(P=0.283);在肝脾念珠菌病、真菌血症及不明部位感染患者中,各用药组患者疗效相似;6周时各组存活率分别为86.2%、87.1%、70.6%和72.7%。伊曲康唑和伏立康唑常见副反应主要为胃肠道反应和轻度低钾血症,前者副反应有胃肠道反应(12.1%)、低钾血症(20.7%),伏立康唑组个别患者出现视觉异常(9.7%)和椎体外系症状(6.4%);卡泊芬净毒副反应轻微,仅见胃肠道反应(15.4%);脂质体两性霉素B组毒副反应较常见,为寒战发热(81.8%)、低钾血症(100%)、胃肠道反应(18.2%)和肝损害(9.1%)。结论伊曲康唑、伏立康唑、卡泊芬净和脂质体两性霉素B在恶性血液病合并IFD中总体疗效、分层诊断疗效以及6周存活率相当,临床治疗可根据患者特点选择个性化用药方案。
Objective To explore the total treatment effect, layered diagnostic treatment effect, the relationship between effect and site of infection and common side effects of commonly used antifungal agents such as itraconazole, Voriconazole, caspofungin and amphoteriein B liposome in invasive fungal infection with hematologic malignancies. Methods The clinical data of 117 cases of patients with hematologic malignancies combining with invasive fungal infection hospitalized in our department from Jan,2005 to Aug,2008 were retrospectively analyzed. Results The total effect rates of itraeonazole, Voriconazole, caspofungin and amphotericin B liposome were 69.0% （ 40/58 ）, 77.4% （ 24/31 ）, 64. 7 % （ 11/17 ） and 63.6% （ 7/11 ） respectivley（ P = 0. 726 ）. In patients with pulmonary infection, the effect rates of the agents were 63.0% （ 17/27 ）, 85.7% （ 12/14）,50.0% （ 4/8 ） and 62. 5 % （ 5/8 ） respectively （ P = 0. 283 ）, which itraconazole group was higher than that of the other agents. The effect rates of the 4 groups have similar rates in patients with liver and spleen candidiasis,fungemia and infections with unknown origin. The rates of 6 weeks survival were 86. 2%, 87. 1%, 70. 6% and 72. 7% respectively. The common side effects of itraconazole and Vorieonazole were mainly gastrointestinal reaction and mild hypokalemia. There were few patients showed gastrointestinal reaction （ 12. 1% ） and hypokalemia （20. 7% ） in the former. Some individual showed visual abnormity （ 9.7% ） and external vertebral body symptoms （ 6.4% ）. caspofungin showed mild toxic and side effects, which was only gastrointestinal reaction（ 15.4% ）, while they were common in amphotericin B liposome group, which were Chill and fever （81.8 % ） , hypokalemia （ 100% ） , gastrointestinal reaction （ 18.2% ） and liver damage（9. 1% ）. Conclusion The total effect,layered diagnostic effect and 6 weeks survival rates were similar in itraconazole, Voriconazole, caspofungin and amphoteriein B liposome in patients with hematologic malignancies combining with invasive fungal infection.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2008年第11期999-1002,共4页
Chinese Journal of Practical Internal Medicine
