国产两性霉素B单用或联合其他抗真菌药治疗恶性血液病并真菌感染54例临床分析  

Clinical study of domestic amphotericin B or in combination with other antifungal drugs therapy 54 cases of malignant hematologic patients with invasive fungal disease

作　　者：刘静[1] 季海龙 赵芳[1] 张睿[1] 尹凤雷[1] 曹婷婷[1] 马洪玉[1] 许卫星[1] 王娟[1] LIU Jing;JI Hai-long;ZHAO Fang;ZHANG Rui;YIN Feng-lei;CAO Ting-ting;MA Hong-yu;XU Wei-xing;WANG Juan(Department of Haematology,Cang Zhou center hospital,Hebei 061000,China)

机构地区：[1]河北省沧州市中心医院血液内一科,沧州061000

出　　处：《中国真菌学杂志》2018年第2期83-86,90,共5页Chinese Journal of Mycology

摘　　要：目的探讨国产两性霉素B单药或联合其他抗真菌药物治疗恶性血液病合并侵袭性真菌病(IFD)患者的有效性、安全性。方法回顾性分析2013年4月~2016年4月我科收治的54例恶性血液病首次合并IFD患者采用国产两性霉素B及联合其他抗真菌药物的临床资料。结果 54例患者经治疗后总有效率为88.9%。两性霉素B组、两性霉素B联合伏立康唑组、两性霉素B联合卡泊芬净组有效率分别为76.2%(16/21例)、96.4%(27/28例)、100%(5/5例)。本组患者以中性粒细胞的恢复、吸烟史为主要易感因素(P<0.05)。肺部CT多可见斑片状磨玻璃影63.0%(34/54例)、实变11.1%(6/54例)、结节14.8%(8/54例)。本研究主要不良反应为低钾血症、肝脏损害。结论国产两性霉素B对于恶性血液病合并IFD患者仍为经济、安全、有效的抗真菌经典药物,单药治疗效果不佳时联合其他抗真菌药物可增强疗效,虽不良反应发生率有所增加,但予治疗则可以控制,从而达到更积极的抗真菌治疗、提高治疗有效率、降低病死率的目的。Objective To evaluate the efficacy and safety of domestic amphotericin B or in combination with other antifungal drugs in malignant hematologic patients with invasive fungal disease(IFD).Methods A retrospective clinical analysis was performed based on 54 patients with hematologic malignancies who firstly infected IFD were treated by amphotericin B or combinated with other antifungal drugs during April 2013 and April 2016 in our department.Results Overall response rate was 88.9%.The response rates of amphotericin B,amphotericin B combined with voriconazole,amphotericin B combined with caspofungin were 76.2%(16/21 cases),96.4%(27/28 cases),100%(5/5 cases).The main risk factors of the patients were the recovery of neutrophils and smoking history(P<0.05).The common lung CT findings of the patients were patchy ground glass shadow 63.0%(34/54 cases),consolidation 11.1%(6/54 cases),nodule 14.8%(8/54 cases).The major adverse reactions of the patients were hypokalemia,liver damage.Conclusion The domestic amphotericin B for malignant hematologic patients with IFD are economic,safe and effective antifungal drugs.If it is ineffective,then combined with other antifungal drugs can enhance curative effect.Although increased incidence of adverse reactions,but they can be controlled,so as to achieve more aggressive antifungal treatment,improve the treatment effectiveness and reduce the case fatality rate.

关 键 词：两性霉素B 恶性血液病 侵袭性真菌病 

分 类 号：R519[医药卫生—内科学]