不同时机两性霉素B脂质体治疗慢性阻塞性肺疾病合并侵袭性肺部真菌感染的疗效及安全性探讨  

Evaluation of efficacy and safety of the different timing of amphotericin B liposome treatment of COPD with invasive pulmonary fungal infections patients

作　　者：祁春艳[1] 张深栾 何志红[1] 王红[1] 毕文淼[1] 张红红[1] 金颖[1] 张国宏[1] 刘静[2] 

机构地区：[1]石家庄市第一医院呼吸二科,河北省050000 [2]石家庄市第一医院预防保健科,河北省050000

出　　处：《中华临床医师杂志（电子版）》2013年第5期73-75,共3页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨不同时机两性霉素B脂质体治疗慢性阻塞性肺疾病(COPD)合并侵袭性肺部真菌感染(IPFI)的疗效及安全性。方法本文回顾性分析我科2010年8月至2012年2月,COPD合并IPFI的28例患者应用两性霉素B脂质体的临床资料,其诊断标准参见中华医学会呼吸分会制定的《慢性阻塞性肺病诊治规范2007修订版》和《侵袭性肺部真菌感染的诊断标准与治疗原则(草案)》,观察并探讨了不同时机两性霉素B脂质体治疗COPD合并IPFI有效性及治疗时机选择等,治疗期间监测肺影像学、肝肾功能电解质、体温等变化,以观察两性霉素B脂质体不良反应。结果临床诊断、拟诊各22、6例;抢先/经验治疗组有效率为76.47%,高于挽救/目标治疗组的45.45%,差异有统计学意义(P<0.05);疗程比较方面:挽救治疗组疗程为(22.32±5.45)d,长于抢先治疗组的(13.40±4.34)d,差异有统计学意义(P<0.05);不良反应发生率比较:挽救治疗组不良反应率(57.14%)高于抢先治疗组不良反应率(39.29%),且差异具有统计学意义(P<0.05)。结论两性霉素B脂质体是治疗COPD合并IPFI安全有效的药物,抢先治疗能提高疗效,且能减少不良反应发生率,临床工作中值得进一步研究证实。Objective To investigate the efficacy and safety of the different timing of amphotericin B liposome treatment of COPD with invasive pulmonary fungal infections patients.Methods The clinical data of 28cases COPD patients with IPFI treated by amphotericin B liposome between Aug 2010 and Feb 2012 were retrospectively analyzed.The study was designed to investigate efficacy and safety of the different timing of amphotericin B liposome treatment of COPD with invasive pulmonary fungal infections patients.Lunges image,liver and kidney function were monitored during the period of treatment.Results There were 22 probable cases COPD patients with IPFI,and 6 possible cases.The over all effective rate of preemptive/empirical therapy group （76.47%）was higher than that in goal/rescue therapy group（45.45%）.The average duration of the amphotericin B liposome in therapy of the effective group was longer than that of ineffective group [（22.32 ±5.45） d vs.（13.40 ± 4.34） d,P 〈0.05].Drug-related side effects between the two groups were found that preemptive/empirical therapy group was lower than that of goal/rescue therapy group during treatment.Condusions Amphotericin B liposome is an effective and safe antifungal drug for COPD patients with IPFI.Preemptive therapy may improve the curative effect.

关 键 词：肺疾病 慢性阻塞性 两性霉素B 侵袭性肺部真菌感染 

分 类 号：R519[医药卫生—内科学]