泊沙康唑预防性抗真菌治疗在重型地中海贫血儿童干细胞移植中的应用  

Oral posaconazole as antifungal prophylaxis in the pediatric patients with major thalassemia following allogeneic stem cell transplantation

作　　者：陆婧媛[1] 洪秀理[1] 陈亚玫[1] 庄燕红[1] 胡嘉升[1] 颜秀珍[1] 鹿全意[1] LU Jingyuan;HONG Xiuli;CHEN Yamei;ZHUANG Yanhong;HU Jiasheng;YAN Xiuzhen;LU Quanyi(Department of Hematology,Zhongshan Hospital,Xiamen University,Xiamen Fujian 361004,China)

机构地区：[1]厦门大学附属中山医院血液科,福建厦门361004

出　　处：《中国感染与化疗杂志》2020年第2期125-130,共6页Chinese Journal of Infection and Chemotherapy

基　　金：福建省科技计划引导项目(2019D009)。

摘　　要：目的探讨泊沙康唑预防性抗真菌治疗在重型地中海贫血儿童干细胞移植中的疗效和安全性。方法分析2017年2月-2019年7月在厦门大学附属中山医院完成的38例重型地中海贫血患儿异基因干细胞移植的临床资料。移植过程中中性粒细胞<0.5×10^9/L的第1天开始同步口服泊沙康唑每次4 mg/kg,3次/d,持续服用至中性粒细胞恢复正常,或发生侵袭性真菌病(IFD),或发生无法耐受的不良反应。记录并统计泊沙康治疗期间IFD发生率,临床不良反应发生率,测定血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、肌酐,以及环孢素A的血药浓度水平。结果38例患者中临床诊断IFD 1例,拟诊IFD 1例,真菌感染发生率为5.3%。未发生3级以上胃肠道反应(恶心、呕吐、腹泻)、皮疹、肌酐升高。3级肝功能损害事件发生率为7.9%(3/38),停药率5.3%(2/38),不同Pesaro分级之间肝功能损害事件发生率差异无统计学意义。结论泊沙康唑预防性抗真菌治疗在该组接受造血干细胞移植的重型地中海贫血患儿中的应用有效而安全。Objective To evaluate the efficacy and safety of posaconazole as oral antifungal prophylaxis in the pediatric patients with major thalassemia following allogeneic stem cell transplantation.Methods This analysis was conducted with the clinical data of 38 children with major thalassemia who underwent allogeneic stem cell transplantation in Zhongshan Hospital of Xiamen University from February 2017 to July 2019.In transplantation process,posaconazole was taken orally at 4 mg/kg,3 times a day if neutrophils<0.5×10^9/L.The use of posaconazole continued until recovery of neutrophils deficiency,or occurrence of invasive fungal disease(IFD),or development of intolerable adverse reactions.The incidence of IFD,adverse reactions,ALT,AST,total bilirubin,direct bilirubin,creatinine,and blood concentration of cyclospore A(CsA)were recorded and statistically analyzed.Results Among the 38 patients,1 was considerd to be probable IFD,and another was considerd to be possible IFD.The incidence of fungal infection was 5.3%.No gastrointestinal reactions(nausea,vomiting or diarrhea),rash,or elevated creatinine above grade 3 occurred.The incidence of grade 3 hepatic impairment was 7.9%(3/38)and discontinuation rate was 5.3%(2/38).The incidence of hepatic impairment did not show significant difference between different Pesaro risk grades.Conclusions Oral posaconazole taken as antifungal prophylaxis is effective and safe in pediatric patients with major thalassemia following allogeneic stem cell transplantation.

关 键 词：地中海贫血 造血干细胞移植 泊沙康唑 侵袭性真菌病 儿童 

分 类 号：R978.5[医药卫生—药品]