恶性血液病患者侵袭性曲霉菌感染的临床特征及治疗分析  

Clinical Characteristics and Efficacy of anti-Aspergillus Therapy in Patients with Hematological Malignancies and Invasive Aspergillosis

作　　者：李艳[1,2] 高丽[1] 王莉莉[1] 王全顺[1] 李红华[1] 于力[1] 

机构地区：[1]中国人民解放军总医院血液科,北京100853 [2]南开大学医学院,天津300071

出　　处：《中国实验血液学杂志》2011年第5期1289-1293,共5页Journal of Experimental Hematology

基　　金：首都医学科研发展基金(2007-2040)

摘　　要：本研究旨在分析恶性血液病化疗或造血干细胞移植(hematopoietic stem cell transplantation,HSCT)患者合并侵袭性曲霉菌感染(invasive aspergillosis,IA)的临床特征及不同抗霉菌治疗的效果和安全性。通过回顾性分析恶性血液病化疗或HSCT病例,根据IA的诊断标准进行评估,分析其临床特征、诊断依据,并按接受的不同治疗分组评价抗霉菌治疗效果及安全性,并分析影响疗效的因素。结果表明,回顾性诊断IA 30例,其中确诊2例,临床诊断19例,拟诊9例。HSCT后IA 19例,主要发生在晚期(>40天)。伏立康唑单药治疗8例,卡泊芬净单药治疗6例,两药联合7例,有效率及开始治疗到有效的时间(time interval from treatment to successful response,TTR)分别为87.5%、50%、85.7%和38、20、36天。联合用药有效率好于单药(p<0.05),TTR差异无显著性(p>0.05)。影响疗效的因素有年龄、HSCT、GVHD和CMV及既往侵袭性真菌感染(invasive fungal infection,IFI)病史等(p<0.05)。各药物均引起不同程度的肝肾损伤,但不同药物之间、联合用药与单药之间对肝肾的损伤程度无显著性差异(p>0.05)。结论:IA仍然是恶性血液病化疗或HSCT患者严重的并发症,抗霉菌治疗联合用药疗效可能好于单药,且不增加肝肾副作用,安全性好;年龄、HSCT、既往IFI病史等可影响疗效。This study was aimed to analyze the clinical features,anti-fungal therapeutic efficacy and safety in hematological malignancy patients with invasive aspergillosis（IA） after hematopoietic stem cell transplantation（HSCT） or chemotherapy.The patients with hematological malignancies received chemotherapy or HSCT were analyzed retrospectively,then the clinical characterisitics and diagnosis were analyzed according to the diagnostic criteria for IA.The efficacy and safety of anti-Aspergillus therapy,and the factors influencing therapeutic response were evaluated.The results showed that out of 30 cases with IA,2 were proven,19 were probable,9 were possible,and 19 were diagnosed after HSCT,most in the late period after-HSCT（40 d）.8 cases received fluconazol only,6 received caspofungin only,7 received combined therapy.The efficacy and time interval from the first day of treatment to successful response（TTR） were 87.5%,50% and 85.7% and 38,20 and 36 days,respectively.Combined therapy is better than single drug treatment（p0.05） while the TTR was not significantly different between them.The factors influencing the therapeutic efficacy were as followes： age,HSCT,GVHD and CMV,previous IFI and so on（p0.05）.All the anti-Aspergillus medicines resulted in some injury of hepatic and renal function.However,there were no significant difference between the drugs or between combination and single drug therapy（p0.05）.It is concluded that IA is also the major and severe complication in the patients with hematological malignancies or received HSCT.Combined therapy for anti-aspergillus is better than single drug in efficacy and safety,without increasing the adverse drug reactions for hepatic and renal function.The efficacy of anti-aspergillus may be related to age,HSCT,GVHD and CMV,previous IFI and so on.

关 键 词：侵袭性曲霉菌感染 恶性血液病 造血干细胞移植 化疗 伏立康唑 卡泊芬净 

分 类 号：R519.7[医药卫生—内科学] R733.7[医药卫生—临床医学]