氟康唑预防血液病患者真菌感染的疗效分析  

Effectiveness analysis of fluconazole prophylaxis of fungus infection in patients with hematological diseases

作　　者：唐暐[1] 王苓[1] 赵维莅[1] 陈玉宝[1] 沈志祥[1] 胡炯[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,上海200025

出　　处：《检验医学》2010年第7期529-532,共4页Laboratory Medicine

摘　　要：目的评价接受大剂量化疗和自体造血干细胞移植（HSCT）患者氟康唑200~400 mg口服或静脉预防真菌感染的疗效。方法总结2008至2009年上海市瑞金医院骨髓移植病区35例血液恶性疾病患者42例次大剂量化疗和自体HSCT,采用氟康唑200-400 mg口服或静脉预防真菌感染直至粒细胞缺乏得以恢复,所有粒细胞缺乏伴发热的患者均接受广谱抗菌药物治疗,结合高分辨计算机断层扫描（CT）和真菌病原学检测即曲霉半乳甘露聚糖（GM）抗原和1-3-β-D葡聚糖（BDG）抗原的检测结果,调整、指导临床的抗真菌治疗。结果本试验入组患者的外周血白细胞（WBC）计数谷值的中位数为0.1×10^9/L[（0.1-0.5）×10^9/L]。粒细胞缺乏（中性粒细胞〈0.5×10^9/L）持续时间的中位数为9 d（2-21 d）,大剂量化疗组和自体HSCT组间差异无统计学意义（P=0.36）。6例次（14.3%）从未出现粒细胞缺乏伴发热事件,36例次（85.7%）出现了粒细胞缺乏伴发热事件,发热持续时间的中位数为4.5 d（1-13 d）,大剂量化疗组和自体HSCT组患者中粒细胞缺乏伴发热的发生率差异无统计学意义（P=0.38）。其中7例虽经广谱抗菌药物经验性治疗,但仍持续发热7 d以上,GM/BDG试验动态观察和胸部CT扫描,尚无1例达到侵袭性真菌感染（IFI）的临床诊断和确诊标准。总共只有3例接受经验性广谱抗真菌的治疗,占粒细胞缺乏伴发热患者的8.3%。结论对于接受阿糖胞苷为主的大剂量化疗和自体HSCT的血液恶性疾病患者,与接受异体HSCT治疗患者不同,其曲霉感染的风险相对比较低。因此应用氟康唑作预防治疗即可达到满意的预防真菌感染疗效,无需应用广谱抗真菌药物进行预防治疗。Objective To evaluate the effectiveness of fluconazole 200-400 mg by oral and intravenous administration for antifungal prophylaxis in patients with high-dose chemotherapy or autologous hematopoietic stem cell transplantation（HSCT）.Methods From Ruijin hospital during 2008-2009,35 patients with hematological malignancy received 21 cycles high-dose chemotherapy or 21 cycles of autologous HSCT.All these patients received fluconazole 200-400 mg by oral and intravenous administration as antifungal prophylaxis throughout the neutropenia phase.The patients with neutropenic fever were received broad spectrum antibiotics and computed tomography（CT） scan,which was galactomannan（GM） antigen/1-3-beta-D glucosans（BDG） antigen assay monitoring to guide the antifungal treatment.Results After high-dose chemotherapy or autologous HSCT,neutropenia occurred in all patients with median nadir white blood cell（WBC） level at 0.1×10^9/L [（0.1-0.5）×10^9/L] for a median of 9 d（2-21 d）.There was no significant difference between high-dose chemotherapy and autologous HSCT（P=0.36）.6 cases（14.3%） were not found neutropenic fever.A total of 36 cases（85.7%） had neutropenic fever with a median of 4.5 d（1-13 d）.The incidence and duration of neutropenia and neutropenic fever had no statistical significance in the high-dose chemotherapy and autologous HSCT（P=0.38）.Though a total of 7 patients failed to respond to broad spectrum antibiotics with persistent fever over 7 d,but no one was in line with the diagnosis standard of invasive fungal infection（IFI）.Only 3 cases（8.3% in neutropenic fever patients） received broad spectrum antifungal treatment.Conclusions In patients with hematological malignancy who receive cytarabine-based high-dose chemotherapy and autologous HSCT,fluconazole prophylaxis is effective.Unlike those patients who receive allogeneic HSCT,no broad spectrum antibiotics are necessary as prophylaxis due to the relative low risk of Aspergillus infection.

关 键 词：氟康唑 曲霉感染 移植 半乳甘露聚糖抗原试验 

分 类 号：R446.5[医药卫生—诊断学]