米卡芬净治疗脓毒症对侵袭性真菌感染发生率及血清BG和GM水平的影响  

Influence of micafungin on incidence of invasive fungal infection and levels of serum BG and GM in sepsis patients

作　　者：孙勇 朱园园 张珂 王其亮 窦晓静 SUN Yong;ZHU Yuan-yuan;ZHANG Ke;WANG Qi-liang;DOU Xiao-jing(Qingdao Hospital of Traditional Chinese Medicine(Qingdao Haici Hospital),Qingdao,Shandong 266000,China)

机构地区：[1]青岛市中医医院(青岛市海慈医院)药剂科,山东青岛266000

出　　处：《中华医院感染学杂志》2022年第13期2034-2038,共5页Chinese Journal of Nosocomiology

基　　金：山东省卫生计生委科研基金资助项目(1926124)。

摘　　要：目的 探讨米卡芬净治疗脓毒症对侵袭性真菌感染(IFI)发生率及血清(1,3)-β-D-葡聚糖(BG)和半乳甘露聚糖(GM)水平的影响。方法 选取2017年10月-2020年10月青岛市中医医院收治的72例获得性脓毒症患者为研究对象,随机数字表法分为研究组36例和对照组36例,对照组利用广谱抗菌药物+安慰剂治疗,研究组采用广谱抗菌药物+米卡芬净治疗,均治疗14 d,比较两组患者IFI发生率,治疗前后血清BG、GM、炎性因子及免疫指标水平。结果 治疗14 d后,研究组外周血GM、BG低于对照组(P<0.05);研究组血清炎症因子白细胞介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平均低于对照组;研究组免疫球蛋白(Ig)G、IgA、IgM、淋巴细胞总数(LYM)水平高于对照组(P<0.05)。治疗后,研究组IFI发生率为2.78%(1/36)低于对照组16.67%(6/36),差异有统计学意义(P<0.05),研究组28 d病死率为13.89%(5/36),与对照组25.00%(9/36)比较,无统计学差异。结论 米卡芬净治疗可显著降低获得性脓毒症患者IFI发生率,降低血清BG和GM水平,改善血清炎症因子和免疫指标,疗效明显。OBJECTIVE To explore the influence of micafungin on incidence of invasive fungal infection(IFI) and levels of serum(1,3)-β-D-glucan(BG) and galactomannan(GM) in sepsis patients. METHODS A total of 72 patients with acquired sepsis who were treated in Qingdao Hospital of Traditional Chinese Medicine from Oct 2017 to Oct 2020 were recruited as the study objects and randomly divided into the study group with 36 cases and the control group with 36 cases. The control group was treated with broad spectrum antibiotics plus placebo, while the study group was treated with broad spectrum antibiotics plus micafungin, both groups were treated for 14 days. The incidence of IFI, levels of serum BG, GM, inflammatory factors and immune function indexes were compared between the two groups of patients before and after treatment. RESULTS The levels of peripheral blood GM and BG of the study group were lower than those of the control group after the treatment for 14 days(P<0.05);the levels of serum inflammatory factors interleukin-6(IL-6), procalcitonin(PCT), tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) of the study group were lower than those of the control group;the levels of immunoglobulins(Ig)G, IgA, IgM and lymphocytes of the study group were higher than those of the control group(P<0.05). The incidence of IFI of the study group was 2.78%(1/36) after the treatment, lower than 16.67%(6/36) of the control group, and there was significant difference(P<0.05);the 28-day mortality rate of the study group was 13.89%(5/36), the control group 25.00%(9/36), and there was no significant difference. CONCLUSION The incidence of IFI can be remarkably reduced in the patients with acquired sepsis when they are treated with micafungin, it can reduce the levels of serum BG and GM and improve the serum inflammatory factors and immune indexes, with the curative effect remarkable.

关 键 词：米卡芬净 脓毒症 侵袭性真菌感染 (1 3)-β-D-葡聚糖 半乳甘露聚糖 

分 类 号：R631[医药卫生—外科学]