联合应用两性霉素B、科赛斯、伊曲康唑治疗急性放射病合并侵袭性阿萨丝孢酵母菌感染1例报告  

Combined Amphotec(amphotericin B) with Caspofungin(concidas) and Itraconazole injection in the treatment of an refractory disseminated Trichosporon Asahii of an acute radiation sickness

作　　者：乔建辉[1] 余长林[1] 郭梅[1] 王丹红[1] 孙琪云[1] 葛飞娇[2] 张石[1] 陈建魁[3] 尹秀云[3] 艾辉胜[1] 

机构地区：[1]解放军第307医院血液科,北京100071 [2]解放军第307医院肿瘤科,北京100071 [3]解放军第307医院检验科,北京100071

出　　处：《解放军医学杂志》2007年第5期434-436,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家863计划资助项目(2002AA216081)

摘　　要：目的报道1例极重度骨髓型急性放射病合并播散性阿萨丝孢酵母菌感染的诊治经过。方法2004年10月24日山东济宁发生1例极重度骨髓型放射病病人,照后3天经造血干细胞移植获造血重建,但造血恢复后发生严重的播散性阿萨丝孢酵母菌感染。结果该患者采用超强的联合抗真菌治疗及对症支持,静脉累积用两性霉素B2965mg、伊曲康唑静脉4000mg、科赛斯3020mg,感染暂时控制,但最终死于急性放射病及感染所致的多脏器功能衰竭。结论此三联抗真菌治疗播散性阿萨丝孢酵母感染,治疗有效,未见明显毒性增加。该病人的救治过程提示对极重度骨髓型急性放射病,解决了造血问题之后,促进免疫重建及组织损伤修复,控制全身的放射损伤及感染是争取病人长期存活的关键。Objective To report the diagnosis and treatment of an extremely severe bone marrow form of acute radiation sickness complicated with disseminated Trichosporon Asahii in Jining,Shandong province, China. Methods An extremely severe bone marrow form of acute radiation sickness was transfered to our hospital 3 days after the accident on October 24,2004. The patient was performed allogeneic stem cell transplantion from his brother and soon acquired hematogenesis recovery, however, refractory disseminated Trichosporonosis （mainly lung） then occured in the patient, after the hemato-reconstitusion,and gradually aggravate. Result Strong support treatment and high dosage combination of drug therapy were used to combat fungi ,the accumulative dose of Ampghotec （amphotericin B） was 2965mg, the accumulative dose of itraconazole was 4000mg, and the accumulative dose of Caspofungin （concidas） was 3020mg. The refractory disseminated Trichosporon Asahii was once partially controlled, but the radiation injury and infection were still becoming worse even after many kinds of antiinfecfion drugs, the patient then died of multiple organ failure on d75 after the accident. Condution The combination of Ampghotec with Caspofungin and Itraconazole in the treatment of disseminated Trichosporon Asahii was effective, no related toxicity occured, which has not been reported before. However, with continuously injury of radiation, we couldn＇t cure the Trichosporonosis thoroughly, and the patient finally died of multiple organs failure related with radiation and infection. According to the cliuical treatment of the patient, we also acquired the experience that when we resolve the hematogenesis, to promote the immunologic reconstitution and the tissue damage repair, control the whole body radiation damage and infection will be the key point for this kind of patient to survive.

关 键 词：辐射损伤 真菌病 两性霉素B 科赛斯 伊曲康唑 侵袭性阿萨丝孢酵母菌感染 

分 类 号：R818.05[医药卫生—放射医学] R63[医药卫生—临床医学]