伊曲康唑治疗血液病患者侵袭性真菌感染的疗效及影响因素分析  

An analysis of efficacy and related factors of itraconazole in the treatment of invasive fungal infection in hematological diseases

作　　者：刘春燕[1] 付蓉[1] 吴玉红[1] 阮二宝[1] 瞿文[1] 王国锦[1] 梁勇[1] 王晓明[1] 刘鸿[1] 宋嘉[1] 关晶[1] 王化泉[1] 邢莉民[1] 李丽娟[1] 王珺[1] 邵宗鸿[1] 

机构地区：[1]天津医科大学总医院血液内科,300052

出　　处：《中华内科杂志》2010年第6期504-507,共4页Chinese Journal of Internal Medicine

基　　金：基金项目：国家自然科学基金（30670886、30470749、30971285、30971286）;国家“十一五”科技支撑项目（2008BA161B00）;天津市高等学校科研基金（200317）;高等学校博士学科点专项科研基金（200800620004）;天津市卫生局科技基金项目（03KZ26）;天津市科技支撑计划重点项目（07ZCGYSF00600）;天津市应用基础及前沿技术研究计划（08JCYBJC07800）

摘　　要：目的 分析伊曲康唑在治疗血液病患者合并侵袭性真菌感染（IFI）中的作用及其影响因素.方法 回顾性分析2005-2008年在天津医科大学总医院住院并接受伊曲康唑治疗的IFI患者156例,了解其疗效、影响因素及副作用等.结果 156例IFI患者中92例原发病为恶性血液病,64例为非恶性血液病;IFI拟诊77例,临床诊断79例.伊曲康唑治疗有效94例（63.5%）,无效更换为其他药物54例（36.5%）.恶性血液病、接受过化疗、中性粒细胞绝对值〈0.5×109/L、真菌培养阳性、合并细菌感染患者伊曲康唑有效率低.年龄、体温、既往应用抗生素、G试验结果、感染部位、血红蛋白水平、血小板水平与伊曲康唑治疗疗效无关.5例患者出现药物副作用而停药,包括胃肠道不适3例和心动过速2例.结论 伊曲康唑能够高效、安全地治疗血液病患者合并IFI.原发恶性病、粒细胞缺乏、合并细菌感染、迟用药物会影响伊曲康唑抗真菌的疗效.Objective To investigate the effects and related factors of itraconazole in the treatment of invasive fungal infection （IFI） in the patients with blood diseases （ BD）. Methods A total of 156 BD patients with IFI treated with itraconazole in General Hospital, Tianjin Medical University from 2005 to 2008, were retrospectively analyzed. Results Of these patients, 92 were with underlying malignant BD, and 64 with non-malignant BD; 77 possible IFI, and others proven IFI. A total of 94 （63. 5% ） patients were responded to itraconazole successfully, while 54 （36. 5% ） failed. The underlying malignant BD, post-chemotherapy, neutrophil count less than 0. 5 x 109/L, positive fungus culture, and bacteria infection were related with the response to itraconazole significantly, while patient＇s age, application of other antibiotics,positive C test, IFI localization, haemoglobin level and platelet counts were not Five patients was changed other anti-IFI therapy because of side effects, including gastrointestinal ill （3 cases with nausea or vomiting） and tachycardia （2 cases）. Conclusions Itraconazole was effective and safe in the treatment of IFI in the patients with BD. Underlying malignant BD, agranulocytosis, bacteria infection, and delayed anti-IFI therapy might reduce itraconazole therapeutic effects.

关 键 词：真菌 伊曲康唑 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]