恶性血液病患者侵袭性肺曲霉菌感染的治疗分析  

Analysis of treatment and influence factors of invasive pulmonary aspergillosis in patients with hematological malignancies

作　　者：吴隼[1] 字友梅[1] 黄琰[1] 马栋[1] 杨满[1] 贺立山[1] 

机构地区：[1]新乡医学院第一附属医院血液科,河南新乡453100

出　　处：《中华医院感染学杂志》2014年第16期3990-3992,共3页Chinese Journal of Nosocomiology

基　　金：河南省教育厅基金资助项目(2006320039)

摘　　要：目的研究恶性血液病患者侵袭性肺曲霉菌感染(IPA)抗真菌治疗效果及其影响因素,为临床资料提供参考依据。方法选择2008年1月-2013年4月收治的82例患者,根据不同的用药方案随机分为伏立康唑组28例、卡泊芬净组27例、联合组27例3组,比较各组患者的临床疗效、不良反应,并对疗效的影响因素,采用SAS9.0软件进行分析。结果共调查恶性血液病患者241例,其中IPA 82例,感染率为34.0%;联合组的抗真菌疗效显著优于伏立康唑组、卡泊芬净组(P<0.05);单药与两药联合用药的不良反应差异无统计学意义;年龄≥50岁、接受造血干细胞移植(HSCT)、人类白细胞抗原(HLA)不匹配及既往IPA病史等均是IPA抗真菌治疗疗效的影响因素(P<0.05)。结论伏立康唑与卡泊芬净联合用药的疗效优于单药,且不增加不良反应;年龄、HSCT、HLA不匹配及既往IPA病史等可影响疗效。OBJECTIVE To investigate clinical effect of antifungal therapy for invasive pulmonary aspergillosis（IPA）in patients with hematological malignancies,and analyze the influence factors for the reference for clinical data.METHODS According to the therapeutic regimen,82 patients with hematological malignancies and IPA were randomly divided into 3groups including voriconazole group（n=28）,caspofungin group（n=27）and combination group（n=27）.The clinical effect,adverse reactions,and influence factors of the effect were analyzed with SAS9.0 software.RESULTS Totally 241 patients with hematologic malignancies were investigated in this study,82 cases were diagnosed as IPA,the infection rate was 34.0%.The effect of antifungal therapy in combination group was significantly better than that in voriconazole and caspofungin groups（P0.05）.There was no significant difference in adverse reactions between single-drug treatment and combined-drug treatment（P0.05）.The age≥50years,haematopoietic stem cell transplant（HSCT）,HLA dismatch and IPA history were negative factors for the treatment effect of hematological malignancies combined with IPA.CONCLUSION Combined therapy of voriconazole and caspofungin for hematological malignancies and IPA is better than single medication in efficacy,without increasing the adverse drug reactions.The efficacy of IPA treatment may be related to age,HSCT,HLA dismatch and IPA history.

关 键 词：恶性血液病 侵袭性曲霉菌感染 伏立康唑 卡泊芬净 影响因素 

分 类 号：R733.7[医药卫生—肿瘤]