骨髓增生异常综合征化疗期间真菌感染危险因素及预防性治疗效果  

Risk factors for fungal infection in myelodysplastic syndrome patients during chemotherapy and effect of prophylactic antifungal treatment

作　　者：季璐璐 刘晓荣[1] JI Lu-lu;LIU Xiao-rong(The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院血液内科,江苏苏州215006

出　　处：《中华医院感染学杂志》2021年第13期1946-1951,共6页Chinese Journal of Nosocomiology

基　　金：江苏省自然科学基金资助项目(20191465)。

摘　　要：目的研究骨髓增生异常综合征(MDS)化疗期间真菌感染的危险因素及预防性抗真菌感染治疗的效果。方法回顾性分析2018年1月-2020年1月苏州大学附属第一医院进行化疗的MDS患者2974例临床资料,所有患者均接受预防性抗真菌治疗,其中泊沙康唑组927例、伏立康唑组1263例、伊曲康唑组784例,比较不同抗真菌药物预防效果和不良反应。其中106例患者发生真菌感染(感染组),采用随机数字表在非真菌感染患者中抽取120例为对照组,比较两组临床资料并分析影响真菌感染的危险因素。结果糖尿病、粒细胞缺乏时间和应用糖皮质激素均为MDS患者化疗期间发生真菌感染的独立危险因素(P<0.05),白细胞计数(WBC)和预防性应用泊沙康唑为保护因素(P<0.05);泊沙康唑组真菌感染例数低于伏立康唑组和伊曲康唑组(P<0.05),三种预防方案住院时间和真菌感染病死例数比较,无统计学差异;治疗期间泊沙康唑组肝功能损害和视觉异常发生率低于伏立康唑组和伊曲康唑组(P<0.05),三种预防方案皮疹、腹泻、肝功能损害和头晕乏力发生率比较,无统计学差异。结论MDS患者化疗期间容易发生真菌感染,积极识别相关危险因素并对高危患者应用抗真菌药物进行干预有利于降低感染发生风险,其中泊沙康唑预防效果和安全性均具有一定优势。OBJECTIVE To explore the risk factors for fungal infection in the patients with myelodysplastic syndrome(MDS)patients during chemotherapy and observe the effect of prophylactic antifungal treatment.METHODS The clinical data of 2974 MDS patients who underwent chemotherapy in the First Affiliated Hospital of Soochow University from Jan 2018 to Jan 2020 were retrospectively analyzed,all of the patients received the prophylactic antifungal therapy and were divided into the posaconazole group with 927 cases,the voriconazole group with 1263 cases,and the itraconazole group with 784 cases.The effects of antifungal agents and adverse reactions were compared.Totally 106 patients had fungal infection(the infection group),120 patients were randomly chosen from the patients without fungal infection and set as the control group,the clinical data were compared between the two groups,and the risk factors for the fungal infection were analyzed.RESULTS Diabetes mellitus,agranulocytosis time and use of glucocorticoids were independent risk factors for the fungal infection in the MDS patients during chemotherapy(P<0.05),white blood cell(WBC)counts and prophylactic use of posaconazole were the protective factors(P<0.05).The number of cases of fungal infection was less in the posaconazole group than in the voriconazole group and the itraconazole group(P<0.05).There were no significant differences in the length of hospital stay and number of cases of death due to fungal infection among the three prophylactic regimens.The incidence rates of liver function damage and visual abnormalities of the posaconazole group were significantly lower than those of the voriconazole group and the itraconazole group(P<0.05).There were no significant differences in the incidence rates of rash,diarrhea,liver function damage and dizziness among the three prophylactic regimens.CONCLUSION The MDS patients are prone to have fungal infection during chemotherapy.It is necessary to actively identify the related risk factors and take interventions to the high ri

关 键 词：骨髓增生异常综合征 化疗 真菌感染 危险因素 泊沙康唑 

分 类 号：R551.3[医药卫生—血液循环系统疾病]