伊曲康唑在造血干细胞移植所致真菌感染二级预防中的应用  

Itraconazole in hematopoietic stem cell transplantation for fungal infection caused by the application of two level prevention

作　　者：何慧清[1] 黎伟超[1] 李卫华[1] 林淑华[1] 黄贵年[1] 牛晓敏[1] 

机构地区：[1]中山大学附属中山医院血液内科,广东广州528403

出　　处：《现代预防医学》2012年第10期2594-2595,2597,共3页Modern Preventive Medicine

摘　　要：目的探讨伊曲康唑在造血干细胞移植(HSCT)所致真菌感染二级预防中的应用疗效。方法 2007年1月～2011年6月在某院住院的恶性血液病患者70例,所有患者均为异基因造血干细胞移植(Allo-HSCT),既往化疗时曾经有侵袭性真菌感染(IFI)的病史。2009年7月～2011年6月间的35例患者设为观察组,于Allo-HSCT预处理后中性粒细胞﹤0.5×109/L时或移植0d时开始序贯给予伊曲康唑注射液和口服液预防真菌感染;对照组为历史对照,2007年1月～2009年6月间的35例患者,于Allo-HSCT前1周开始给予氟康唑片预防真菌感染,两组均预防应用至Allo-HSCT后180d。比较两组患者移植期间各阶段真菌感染发生率、真菌感染死亡率及不良反应。结果观察组真菌感染发生率为5.7%(2/35),对照组为22.9%(8/35),差异有统计学意义(P﹤0.05);观察组无1例死于真菌感染,对照组真菌感染死亡率为17.1%(6/35),差异有统计学意义(P﹤0.05);对照组不良反应发生率为8.6%(3/35),观察组为17.2%(6/35),差异无统计学意义(P﹥0.05)。结论伊曲康唑能显著减少既往有IFI的恶性血液病患者HSCT所致真菌感染的发生率及病死率,其安全性、耐受性好,值得在二级预防中推广应用。OBJECTIVE To explore to itraconazole in hematopoietic stem cell transplantation（HSCT）fungal infection caused by two grade prevention in clinical application.METHODS From January 2007-June 2011,70 cases with malignant blood disease were collected in our hospital.All patients underwent allogeneic hematopoietic stem cell transplantation（Allo-HSCT）,Patients with previous chemotherapy had invasive fungal infection（IFI）history.From July 2009 to June 2011,35 patients were collected as the observation group.After pretreatment for Allo-HSCT,when the neutrophil ﹤0.5×109/L or transplantation 0 days,itraconazole injection and oral liquid were sequential given to prevent fungal infection.Compared to historical controls,2007 January to 2009 June,35 patients with Allo-HSCT were given fluconazole tablets to prevent fungal infection one week before treatment,two groups were applied to prevent Allo-HSCT for 180 days.The fungal infection rate,mortality and adverse reaction of fungal infection were compared.RESULTS The fungal infection rate of observation group was 5.7%（2/35）,the control group was 22.9%（8/35）,there was significant difference between them（P﹤0.05）;1 cases of the observation group died of fungal infection,the mortality rate of fungal infection control group was 17.1%（6/35）,and there was significant difference between them（P﹤0.05）;The incidence of adverse reactions of the control group was 8.6%（3/35）,and was 17.2% for the observation group（6/35）,there was significant difference between them（P﹥0.05）.CONCLUSION Itraconazole can remarkably reduce the infection and mortality of IFI HSCT for patients with malignant blood disease caused by fungal.This method is safe and tolerability,which is worthy of two grade prevention application.

关 键 词：伊曲康唑 异基因造血干细胞移植 真菌感染 二级预防 

分 类 号：R378.2[医药卫生—病原生物学]