伏立康唑治疗血液病患者侵袭性真菌感染  

Voriconazole for primary therapy of invasive fungal infection in hematologic patients

作　　者：黄勇[1] 姜尔烈[1] 阎嶂松[1] 魏嘉麟 马巧玲[1] 冯四洲[1] 韩明哲[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所血液病医院,天津300020

出　　处：《中国感染与化疗杂志》2008年第3期190-194,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析伏立康唑治疗血液病患者侵袭性真菌感染(IFI)的疗效和安全性。方法69例血液病并发IFI患者,予以伏立康唑为主的抗真菌治疗,从临床表现、影像学和病原学3个方面评价疗效,同时观察药物的不良反应。结果伏立康唑治疗IFI总有效率67.3%。在病原菌明确的病例中,曲霉属和念珠菌属感染有效率均为70%,1例新型隐球菌感染为显效。单变量分析显示延长伏立康唑治疗疗程(P<0.01)和患者基础病稳定(P=0.014)能显著提高疗效。多因素分析提示治疗疗程和基础病状况是影响伏立康唑疗效的主要因素。伏立康唑主要不良事件是神经精神症状、视觉异常和皮疹;56例可评价病例中8例(14.3%)因不能耐受药物相关不良事件而退出伏立康唑治疗。结论伏立康唑在治疗血液病患者IFI上具有广谱抗真菌功效,同时它所引发的不良事件较少且多能耐受。Objective To evaluate the efficacy and safety of voriconazole for primary therapy of invasive fungal infection （IFI） in hematologic patients. Methods Sixty-nine hematologic patients complicated with proven or probable IFI were treated with voriconazole-based therapy. Efficacy was evaluated by a global assessment of clinical, radiographic, and microbiologic response. Drug-related adverse events （AEs） were also recorded. Results The overall response rate to voriconazole-based therapy was 67.3%. Among patients with infection of identified pathogens, the response rate was 70% for both aspergillosis and candidiasis. The only cryptococcosis was well responded. Univariate analysis showed that long-terra therapy and remission of hematologic disease were significantly associated with favorable outcome. Multivariate analysis showed that the duration of therapy and status of hematologic disease can strongly influence the outcome. Psychoneurosis, visual disturbances, and skin rash were considered the main drug-related AEs. Several patients withdrawed voriconazole treatment for intolerable AEs. Conclusions As an effective and well-tolerated antifungal agent, voriconazole is a promising alternative in hematologic patients with IFI.

关 键 词：伏立康唑 侵袭性真菌感染 血液病 

分 类 号：R55[医药卫生—血液循环系统疾病] R519[医药卫生—内科学]