不同抗真菌药物治疗儿童侵袭性肺曲霉病疗效比较  

Comparison of the effect of different antifungal medicines in treatment of children with invasive pulmonary aspergillosis

作　　者：毛彦娜[1] 田亮[1] 刘炜[1] 李彦格[1] 刘俊闪[2] 宋丽丽[1] 包丰昌[1] 周建文[1] 张红梅[1] 

机构地区：[1]郑州市儿童医院血液肿瘤科,河南郑州450053 [2]郑州市儿童医院血液肿瘤科实验室,河南郑州450053

出　　处：《新乡医学院学报》2016年第9期774-776,779,共4页Journal of Xinxiang Medical University

基　　金：国家自然科学基金-河南人才培养联合基金(编号:U1204806)

摘　　要：目的探讨不同抗真菌药物治疗侵袭性肺曲霉病(IPA)的疗效及安全性。方法收集2008年1月至2013年7月郑州市儿童医院血液肿瘤科IPA患儿96例,根据应用抗真菌药物种类的不同分为伏立康唑组40例、两性霉素B组30例和卡泊芬净组26例。回顾性分析96例患儿影像学及病原学检查结果,并比较3组患儿临床疗效和不良反应。结果 96例IPA患儿中,胸部影像学表现为节段性肺实变45例(46.9%),多发或单发结节阴影38例(39.6%);血清半乳糖(GM)连续2次阳性72例(75.0%)。与卡泊芬净组(69.2%,18/26)比较,伏立康唑组(95.0%,38/40)与两性霉素B组(86.7%,26/30)治疗有效率显著升高(P<0.05);伏立康唑组治疗有效率虽然高于两性霉素B组,但其差异无统计学意义(P>0.05)。与两性霉素B组比较,伏立康唑组、卡泊芬净组患者高热、寒战、低钾血症、肝功能异常等不良反应发生率显著降低(P<0.01);伏立康唑组患儿平均退热时间[(1.5±1.0)d]显著短于卡泊芬净组[(7.0±1.5)d](P<0.05)。结论伏立康唑治疗IPA患儿疗效显著,安全性高,且退热快。Objective To investigate the efficacy and safety of different antifungal medicines in treatment of children with invasive pulmonary aspergillosis （ IPA ）. Methods A total of 96 children with IPA in Department of Hematonosis and Oncosis,Zhengzhou Children＇s Hospital from January 2008 to July 2013 were selected and divided into voriconazole group （ n = 40 ） , amphotericin B group （ n = 30 ） and caspofungin group （ n = 26 ） according to the types of antifungal medicines used. The imageology and aetiology result of the 96 cases were analyzed retrospectively, and the clinical effect and adverse effect were compared among the three groups. Results Of the 96 cases of IPA patients, there were 45 cases （46.9%）of segmental pulmonary consolidation, 38 cases （ 39.6% ） of multiple or single nodule shadows in the chest imaging; 72 cases （75.0%） had twice consecutive positive of serum glactomannan（GM）. The effective rate of vorieonazole（95.0% ,38/dO） and amphoteriein B group（ 86.7% ,26/30） was significantly higher than that of caspofungin group（ 69.2% , 18/26） （P 〈0. 05）. Also the voriconazole group overtops amphotericin B group in effective rates,hut the difference had no statistically significance （P 〉 0. 05 ）. Comparing to amphotericin B group, the incidence of hyperpyrexia, shiver, hypokalemia and hepatic dysfunction were significantly lower in voriconazole and caspofungin groups （ P 〈 0.01 ）. The defervescenee time of voriconazole group [ （ 1.5 ± 1.0） d ] was significantly shorter than that of caspofungin group [ （ 7.0 ± 1.5 ） d ] （ P 〈 0.05 ）. Conclusion Voriconazole can be used to treat IPA with remarkable curative effect and high safety and the deferveseence time needed is rather short.

关 键 词：儿童 侵袭性曲霉菌病 临床特点 伏立康唑 

分 类 号：R725.6[医药卫生—儿科]