两性霉素B3日加量疗法在急性白血病合并侵袭性真菌病患儿中的临床应用  

A3 days dose-escalation method for the administration of amphotericin B for childhood acute leukemia with invasive fungal disease

作　　者：刘莹婷 曹励之[2] 王丹[2] 杨明华[2] LIU Yingting;CAO Lizhi;WANG Dan;YANG Minghua(The Second People's Hospital of Hunan Province,Changsha 410008,China;Department of Pediatrics,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]湖南省第二人民医院,长沙410008 [2]中南大学湘雅医院儿科,长沙410008

出　　处：《中国真菌学杂志》2021年第3期170-175,共6页Chinese Journal of Mycology

基　　金：国家自然科学基金(81100359,81570154)。

摘　　要：目的探讨两性霉素B 3日加量疗法治疗化疗后白血病患儿侵袭性真菌病的疗效及患儿对其的耐受性。方法回顾分析2009年3月—2018年12月于我院收治的使用两性霉素B治疗的发生侵袭性真菌病的急性白血病患儿108例,根据给药方式的不同将其分为A、B两组(A组50例,B组58例);A组5日加至足量;B组3日加至足量;分析两性霉素B相关不良反应及剂量累计相关累积毒性,用药4周后评价疗效。结果A组中确诊及临床诊断患儿治疗有效率为54.5%、B组为80.5%,差异具有统计学意义(P=0.021);两组不良反应差异无统计学意义(P>0.05)。结论两性霉素B 3日加量疗法治疗侵入性真菌病更具优势,有效率明显提高,且两种给药方式不良反应无统计学差异,对于儿童白血病的侵袭性真菌感染,临床工作中可以采用两性霉素B 3日加量疗法,以期迅速达到血药浓度峰值,尽快控制症状,提高疗效。Objective To evaluate the efficacy and safety of 3-day rapid dose escalation treatment of amphotericin B(AmB)in childhood acute leukemia(AL)patients with invasive fungal disease(IFD).Methods Data on 108 AL patients with IFD during March 2009 to December 2018 were collected.Those assigned to standard group(n=50)received standard treatment for 5 days.New Group(n=58)received rapid dose-escalation for 3 days,The rate of adverse events and overall success rate in 4 weeks after initiation of AmB therapy were documented and retrospectively analyzed.Results We found the overall success rate was differed significantly between patients with proven and probable fungal infections in two group and the incidence of adverse events was similar between all patients(54.5%vs.80.5%,P=0.021).Conclusions The 3-day schedule for drug administration of AMB presented a more effective,with less toxicity than the standard approach to treatmentfor childhood acute leukemia patients with IFD.There is nosignificant difference in the rate of AES between the 3-day escalation strategy and the 6-day escalation strategy.So we concluded that three-day dose escalation was better than standard treatment.

关 键 词：两性霉素B 快速加量 侵袭性真菌病 急性白血病 儿童 

分 类 号：R519[医药卫生—内科学]