国产伏立康唑治疗154例侵袭性真菌感染患者的疗效观察
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摘要
目的探讨国产伏立康唑在血液病患者合并侵袭性真菌病(IFD)治疗中的临床疗效、不良反应及相关影响因素。方法收集该院血液科2012年1月至2017年1月住院期间采用国产伏立康唑治疗的IFD患者154例,分析患者的临床特征、影像学特征、病原学特征、分层诊疗时机,临床疗效、不良反应及其影响因素。结果伏立康唑治疗血液病患者合并IFD的总有效率为70.8%,各IFD诊断分层间有效率比较,差异无统计学意义(P=0.077);单因素分析结果显示抗真菌治疗后退热时间(P=0.001)、G试验结果(P=0.017)影响患者的治疗效果;不良反应以电解质紊乱为主(99例,64.3%),但改善迅速且不影响总疗程。结论国产伏立康唑对血液病患者合并IFD治疗效果较好,其不良事件较少且多能耐受。
Objective To evaluate the efficacy,safety,and influencing factors of voriconazole for invasive fungal disease(IFD)in patients with hematologic diseases.Methods Patients with hematologic diseases complicated with IFD in our hospital from Jan 2012 to Jan 2017 were involved in this study.The clinical features,imaging and pathogen distribution,diagnosis and treatment time were analyzed,then the efficacy,adverse reaction,and influencing factors of voriconazole were evaluated.Results The overall effective rate of voriconazole was 70.8%.There was no significant difference in the efficiency among the hematologic diseases complicated with IFD(P=0.077).Univariate analysis showed that antipyretic time after antifungal therapy(P=0.001)and G test results(P=0.017)were significantly associated with favorable outcome.Electrolyte imbalance was the main drug-related adverse reaction(99 cases,64.3%),but it did not affect the efficacy of voriconzole.Conclusion Voriconzole is an effective and well-tolerated antifungal agent for IFD in patients with hematologic diseases.
Objective To evaluate the efficacy,safety,and influencing factors of voriconazole for invasive fungal disease(IFD)in patients with hematologic diseases.Methods Patients with hematologic diseases complicated with IFD in our hospital from Jan 2012 to Jan 2017 were involved in this study.The clinical features,imaging and pathogen distribution,diagnosis and treatment time were analyzed,then the efficacy,adverse reaction,and influencing factors of voriconazole were evaluated.Results The overall effective rate of voriconazole was 70.8%.There was no significant difference in the efficiency among the hematologic diseases complicated with IFD(P=0.077).Univariate analysis showed that antipyretic time after antifungal therapy(P=0.001)and G test results(P=0.017)were significantly associated with favorable outcome.Electrolyte imbalance was the main drug-related adverse reaction(99 cases,64.3%),but it did not affect the efficacy of voriconzole.Conclusion Voriconzole is an effective and well-tolerated antifungal agent for IFD in patients with hematologic diseases.
引文
[1]TANG J L,KUNG H C,LEI W C,et al.High incidences of invasive fungal infections in acute myeloid leukemia patients receiving induction chemotherapy without systemic antifungal prophylaxis:aprospective observational study in Taiwan[J].PLoS One,2015,10(6):e0128410.
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[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[J].中华内科杂志,2017,56(6):453-459.
[5]芦璐,侯明,房淑欣.粒细胞缺乏伴深部真菌感染患者的临床分析及抗菌药物应用[J].中华医院感染学杂志,2014,14(10):3447-3449.
[6]陈银霞,张扬,白菊,等.伏立康唑治疗恶性血液病合并侵袭性真菌感染160例临床分析[J].医学信息,2014,25(12):566-567.
[7]王玲,李华伟,白观臣.伊曲康唑联合重组人粒细胞集落刺激因子治疗中性粒细胞减少的血液病患者侵袭性真菌感染的疗效及安全性评价[J/CD].中华临床医师杂志(电子版),2013,7(7):2826-2829.
[8]胡炯.未确定侵袭性真菌病的诊断和治疗:血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则解读[J].中华内科杂志,2017,56(6):395-397.
[9]蔡学究,戴建强,邓小玲,等.1,3-β-D-葡聚糖和半乳甘露聚糖试验在非粒细胞缺乏侵袭性肺曲霉病诊断中的应用研究进展[J].广西医学,2017,39(6):871-873.
[10]林贵兰,马晓波,房丽丽,等.(1,3)-β-D-葡聚糖连续监测在抗真菌药物治疗中的评价[J].中华医院感染学杂志,2016,26(1):37-39.
[11]龙军,张耀康,江凌晓,等.2008-2012年肺部真菌感染临床分析[J].中华医院感染学杂志,2014,24(13):3240-3242.
[12]马凤莲,杨铁生.157例深部真菌感染和药敏结果分析[J].中国实验诊断学,2010,14(11):1751-1752.
[13]王智,冯金萍,陆时运,等.伏立康唑静脉序贯口服治疗血液病患者合并侵袭性真菌感染的疗效[J].中国全科医学,2011,14(8):899-902.
[14]黄勇,姜尔烈,阎嶂松,等.伏立康唑治疗血液病患者侵袭性真菌感染[J].中国感染与化疗杂志,2008,8(3):190-194.
[15]陈冬,裴仁治,陆滢,等.伏立康唑治疗血液病患者侵袭性真菌感染疗效分析[J].中华医院感染学杂志,2015,25(22):5163-5165.
[2]MAERTENS 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―2009update[J].Bone Marrow Transplant,2011,46(5):709-718.
[3]KO B S,CHEN W T,KUNG H C,et al.2016guideline 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,2017,30(11):1145-1147.
[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[J].中华内科杂志,2017,56(6):453-459.
[5]芦璐,侯明,房淑欣.粒细胞缺乏伴深部真菌感染患者的临床分析及抗菌药物应用[J].中华医院感染学杂志,2014,14(10):3447-3449.
[6]陈银霞,张扬,白菊,等.伏立康唑治疗恶性血液病合并侵袭性真菌感染160例临床分析[J].医学信息,2014,25(12):566-567.
[7]王玲,李华伟,白观臣.伊曲康唑联合重组人粒细胞集落刺激因子治疗中性粒细胞减少的血液病患者侵袭性真菌感染的疗效及安全性评价[J/CD].中华临床医师杂志(电子版),2013,7(7):2826-2829.
[8]胡炯.未确定侵袭性真菌病的诊断和治疗:血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则解读[J].中华内科杂志,2017,56(6):395-397.
[9]蔡学究,戴建强,邓小玲,等.1,3-β-D-葡聚糖和半乳甘露聚糖试验在非粒细胞缺乏侵袭性肺曲霉病诊断中的应用研究进展[J].广西医学,2017,39(6):871-873.
[10]林贵兰,马晓波,房丽丽,等.(1,3)-β-D-葡聚糖连续监测在抗真菌药物治疗中的评价[J].中华医院感染学杂志,2016,26(1):37-39.
[11]龙军,张耀康,江凌晓,等.2008-2012年肺部真菌感染临床分析[J].中华医院感染学杂志,2014,24(13):3240-3242.
[12]马凤莲,杨铁生.157例深部真菌感染和药敏结果分析[J].中国实验诊断学,2010,14(11):1751-1752.
[13]王智,冯金萍,陆时运,等.伏立康唑静脉序贯口服治疗血液病患者合并侵袭性真菌感染的疗效[J].中国全科医学,2011,14(8):899-902.
[14]黄勇,姜尔烈,阎嶂松,等.伏立康唑治疗血液病患者侵袭性真菌感染[J].中国感染与化疗杂志,2008,8(3):190-194.
[15]陈冬,裴仁治,陆滢,等.伏立康唑治疗血液病患者侵袭性真菌感染疗效分析[J].中华医院感染学杂志,2015,25(22):5163-5165.