伏立康唑治疗老年恶性血液病侵袭性真菌感染疗效分析  

Efficacy of voriconazole in treatment of invasive fungal infections in elderly patients with hematological malignancies

作　　者：陆敏秋[1,2] 白砚霞[1,2] 李真[1,3] 左杏果[1,2] 吴梦青[1,2] 石磊[1,2] 褚彬[1,2] 

机构地区：[1]北京积水潭医院 [2]北京大学第四临床医学院血液科,北京100035 [3]北京大学第四临床医学院感染疾病科,北京100035

出　　处：《中华医院感染学杂志》2012年第14期3153-3155,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨伏立康唑在老年恶性血液病侵袭性真菌感染患者中的临床疗效及不良反应。方法对2007年5月-2011年12月的50例老年恶性血液病侵袭性真菌感染患者的临床资料进行回顾性分析。结果确诊4例,临床诊断20例,拟诊26例;14例患者为初始治疗,36例患者为挽救治疗;总有效率为74.0%,确诊组4例均有效,临床诊断组有效率70.0%,拟诊组有效率73.1%;初始治疗有效率85.7%,挽救治疗有效率69.4%;经过静脉注射的患者有效率76.3%,单纯口服治疗有效率66.7%,两组差异无统计学意义;10例患者曲霉菌属感染,6例有效,曲霉菌属清除;粒细胞缺乏影响伏立康唑疗效,粒细胞缺乏组有效率58.4%,低于无粒细胞缺乏组的88.5%(P<0.05);主要不良反应为肝功能异常、视觉障碍、幻觉,停药后可消失,未观察到肾毒性及心脏毒性。结论伏立康唑可安全有效地治疗老年恶性血液病侵袭性真菌感染。OBJECTIVE To clarify the efficacy of voriconazole for the invasive fungal infections（IFI） in the elderly patients with hematological malignancies and observe the adverse reactions.METHODS The clinical data of 50 elderly IFI patients with hematological malignancies who were treated with voriconazole from May 2007 to Dec 2011 were analyzed retrospectively.RESULTS There were 4 cases confirmed,20 cases clinically diagnosed,and 26 cases suspected;there were 14 cases treated with initial therapy,36 cases with rescue therapy;the total effective rate was 74.0%,4 confirmed cases were proven effective to voriconazole,the effective rate of the clinically diagnosed cases was 70.0%,the suspected diagnosis group 73.1%;the effective rate of the initial therapy was 85.7%,the rescue therapy 69.4%;the effective rate of the patients receiving intravenous injection was 76.3%,the patients treated with simple oral administration 66.7%,the differences were not statistically significant;there were totally 10 patients infected with Aspergillus,6 cases were effective and Aspergillus were eradicated.Agranulocytosis affected the efficacy of voriconazole,the response rate of agranulocytosis group was 58.4%,lower than 88.5% of the non-agranulocytosis group（P0.05）;the abnormal liver function,visual impairment,and hallucination were the main adverse reactions,which disappeared as drugs were withdrawn,the renal toxicity and cardiac toxicity were not observed.CONCLUSION Voriconazole is effective and safe,as is applied for the treatment of invasive fungal infections in elderly patients with hematologic malignancies.

关 键 词：伏立康唑 侵袭性真菌感染 恶性血液病 

分 类 号：R978.1[医药卫生—药品]