伏立康唑治疗血液病合并侵袭性真菌病的疗效及安全性观察
摘要
目的观察伏立康唑治疗血液病合并侵袭性真菌病(IFD)的疗效及安全性。方法选择2014年1月至2017年3月安徽省第二人民医院血液科收治的37例血液病合并IFD患者,回顾性分析患者的临床资料,统计分析患者的疗效及安全性。结果37例患者中,完全缓解8例(21. 62%)、部分缓解16例(43. 24%)、稳定5例(13. 51%)、进展7例(18. 92%)、死亡1例(2. 7%),总有效24例,总有效率为64. 86%(24/37)。粒细胞缺乏患者治疗有效率为50. 00%,低于非粒细胞缺乏患者,差异有统计学意义(P <0. 05),年龄、化疗、糖皮质激素、广谱抗菌药物使用对疗效无明显影响。16例患者共出现24例次不良反应,包括低钾血症13例,幻视4例,肝酶升高3例,肾功能异常2例,过敏反应2例,未发现药物不良反应所致停药。结论伏立康唑治疗血液病合并IFD疗效较好,不良反应程度可控。
引文
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[2]MAETENS J,MARCHETTI O,HERBRECHT R,et al.European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients:summary of the ECIL 3-2009 update[J].Bone Marrow Transplant,2011,46(5):709-718.
[3]KO B S,CHEN W T,KUNG H C,et al.2016 guideline strategies for the use of antifungal agents in patients with hematological malignancies or hematopoietic stem cell transplantation recipients in Taiwan[J].J Microbiol Immunol Infect,2018,51(3):287-301.
[4]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第五次修订版)[J].中华内科杂志,2017,56(6):453-459.
[5]方会慧,许杜娟,孙旭群,等.伏立康唑预防/治疗侵袭性真菌病的临床应用分析[J].安徽医药,2018,22(1):163-167.
[6]杨国元.造血系统恶性疾病并发深部真菌感染的诊断和治疗[J].华中医学杂志,2000,24(1):35-36.
[7]丛琳.伏立康唑治疗侵袭性肺曲霉病4例[J].中国感染与化疗杂志,2010,10(4):308-310.
[8]树林.深部真菌感染的诊断与治疗[J].中国临床医生,2001,29(7):13-14.
[9]WALSH T J,ANAISSIE E J,DENNING D W,et al.Treatment of as-pergillosis:clinical practice guidelines of the infectious disease of society of America[J].Clin Infect Dis,2008,46(3):327-360.
[10]COLOMBO A L,GUIMARAES T,SILVA L R,et al.Prospective observational study of candidemia in Sao Paulo Brazil:incidence rate,epidemiology,and predictors of mortality[J].Infect Control Hosp Epidemiol,2007,28(5):570-576.
[11]LIPSETT P A.Surgical critical care:fungal infections in surgical patients[J].Crit Care Med,2006,34(Suppl 9):215-224.
[12]PAPPAS P G,KAUFFMAN C A,ANDES D R,et al.Clinical practice guideline for the management of candidiasis:2016update by the infectious diseases society of America[J].Clin Infect Dis,2016,62(4):e1-e50.