泊沙康唑在异基因造血干细胞移植期间预防侵袭性真菌病的效果和安全性:单中心回顾性分析  

Efficacy and safety of posaconazole in prevention of invasive fungal infections during allogeneic hematopoietic stem cell transplantation:a single-center retrospective analysis

作　　者：张艳芳 娄世峰[1] 陈姝[1] 周慷[1] 罗云[1] 黄曦 邓建川[1] ZHANG Yanfang;LOU Shifeng;CHEN Shu;ZHOU Kang;LUO Yun;HUANG Xi;DENG Jianchuan(Department of Hematology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400010,China)

机构地区：[1]重庆医科大学附属第二医院血液内科,重庆400010

出　　处：《第三军医大学学报》2021年第21期2307-2312,共6页Journal of Third Military Medical University

摘　　要：目的探讨泊沙康唑(posaconazole,PCZ)在异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)期间预防侵袭性真菌病(invasive fungal disease,IFD)的效果和安全性。方法回顾性分析2017年3月至2021年3月本院进行allo-HSCT的80例患者资料,观察移植期间接受泊沙康唑(泊沙康唑组,n=50)和同期接受其他抗真菌药物(对照组,n=30)预防IFD的效果和安全性。结果泊沙康唑组6例(12.0%)发生IFD,其中确诊2例,临床诊断4例。对照组14例(46.7%)发生IFD,其中确诊6例,临床诊断6例,拟诊2例。泊沙康唑组IFD发生率显著低于对照组(P=0.001)。泊沙康唑组一级预防38例,4例(10.5%)发生IFD;二级预防12例,2例(16.7%)发生IFD,一级预防和二级预防对IFD的发生差异无统计学意义(P=0.951)。泊沙康唑组IFD相关病死率显著低于对照组(21.0%vs 61.5%,P=0.030)。不良反应方面,泊沙康唑组肝功异常明显少于对照组(20%vs 46.7%,P=0.012)。结论泊沙康唑能更有效地预防allo-HSCT过程中IFD的发生,减少IFD相关死亡,不良反应更少。Objective To investigate the efficacy and safety of posaconazole(PCZ)in the prevention of invasive fungal disease(IFD)during allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The medical records of 80 patients who received allo-HSCT at our center from March 2017 to March 2021 were retrospectively reviewed and analyzed.They were accordingly divided into PCZ group(n=50)and control group(n=30,taking other anti-fungal drugs).The efficacy and safety of PCZ was analyzed in the prevention of IFD.Results In the PCZ group,6 patients(12.0%)developed IFD,including 2 confirmed cases and 4 clinically diagnosed.While,IFD occurred in 14 cases from the control group,including 6 confirmed,6 clinically diagnosed and 2 suspected cases.The incidence of IFD was significantly lower in the PCZ group than the control group(P=0.001).Moreover,in the PCZ group,38 patients(10.5%)with primary prevention developed 4 cases of IFD,and 2 cases(16.7%)of IFD occurred in 12 patients of secondary prevention,showing no significant difference in the IFD incidence(P=0.951).The IFD-related mortality(21.0%vs 61.5%,P=0.030)and rate of abnormal liver function(20.0%vs 46.7%,P=0.012)were both significantly lower in the PCZ group than the control group.Conclusion PCZ is effective in the prevention of IFD during allo-HSCT,and reduces IFD-related deaths and occurrence of adverse reactions.

关 键 词：泊沙康唑 异基因造血干细胞移植 侵袭性真菌病 预防性抗真菌治疗 

分 类 号：R519[医药卫生—内科学] R617[医药卫生—临床医学]