泊沙康唑在重型再生障碍性贫血强化免疫抑制治疗初级预防真菌感染中的应用  

Posaconazole as primary prevention of fungal infection in intensive immunosuppressive therapy for severe aplastie anemia

作　　者：陈苗 庄俊玲[1] 段明辉[1] 张薇[1] 李剑 朱铁楠 蔡华聪[1] 曹欣欣 冯俊 杨辰 张炎 张路[1] 周道斌[1] 韩冰 

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院血液内科,100730

出　　处：《中华血液学杂志》2018年第2期128-131,共4页Chinese Journal of Hematology

摘　　要：目的评价在初治重型／极重型再生障碍性贫血（SAA／VSAA）患者抗胸腺／淋巴细胞免疫球蛋白（ATG／ALG）联合环孢素A的强化免疫抑制治疗（IST）中，采用泊沙康唑初级预防真菌感染的疗效及安全l眭。方法回顾性分析北京协和医院2013年4月至2017年5月接受强化IST及抗真菌初级预防的58例SAA患者资料，根据抗真菌预防药物分为泊沙康唑预防组和对照组（伊曲康唑或氟康唑预防）．对比两组患者疾病特征、侵袭性真菌病（IFD）预防效果及药物不良反应。结果58例初治SAA／VSAA患者中，泊沙康唑预防组20例，对照组38例（伊曲康唑预防23例，氟康唑预防15例）。两组患者基线特征（性别、年龄、疾病严重程度、病因、起病到治疗间隔时间、ATG／ALG种类）差异均无统计学意义（P值均〉0．1）。泊沙康唑预防组和对照组IFD发生率分别为0和15．8％（P=O．084），对照组6例IFD中确诊、拟诊、未确定各2例；5例为肺部感染，1例为血流感染。在VSAA中，8例泊沙康唑预防组患者无一例发生IFD，15例对照组患者5例发生IFD。泊沙康唑预防组未见明显不良反应。结论在SAA／VSAA的强化IST中，本回顾性分析结果提示采用泊沙康唑初级预防真菌感染有效、安全，对于VSAA患者效果明显。Objective To Evaluate the efficacy of invasive fungal disease （IFD） in patients with severe and safety of posaconazole as primary prevention aplastic anemia （SAA） treated with anti-thymus/ lymphocyte immunoglobulin （ATG/ALG） combined with cyclosporine intensive immunosuppressive therapy （IST）. Methods A retrospective analysis of clinical data of 58 SAA patients who received IST of anti-thymocyte immunoglobulin combining eyclosporine and antifungal prophylaxis during April 2013 to May 2017 in Peking Union Medical College Hospital was performed. The patients were divided into posaconazole prophylaxis group and the control group （itraconazole or fluconazole）. The disease characteristics, IFD prevention effect and adverse drug reaction, curative effect and prognosis of the two groups were compared. Results Posaconazole was used to prevent fungal infection in 20 patients. The other 38 patients were used as the control group. Retrospective analysis showed comparable characteristics （gender, age, disease severity, etiology, interval between the onset of disease to treatment, ATG/ALG type） of both groups. The incidence of IFD were 0 and 15,8% in posaconazole prophylaxis group and the control group, respectively （P-- 0.084）. In the control group, there were 6 cases diagnosed as IFD. Of them, 2 were confirmed, 2 suspected and 2 not identified. Five of the 6 cases were pulmonary infection, 1 bloodstream infections. Of the 6 IFD cases, 5 were very severe aplastic anemia （VSAA）. There was no obvious adverse reaction in posaconazole prophylaxis group. Conclusion Posaconazole is safe and effective for primary prevention of fungal infection of SAA patients receiving IST, especially for the VSAA.

关 键 词：贫血 再生障碍性 免疫抑制治疗 泊沙康唑 

分 类 号：R556.5[医药卫生—血液循环系统疾病]