泊沙康唑预防血液病患者侵袭性真菌感染的效果及影响因素  

Efficacy of posaconazole on preventing invasive fungal disease in patients with hematological disease and its influencing factors

作　　者：梁利杰 房佰俊 曹伟杰[2] 王敏芳[3] 杨海平[4] 白炎亮[5] 王羽 党惠兵[7] 郭学军[8] 王西阁[9] 郭淑利[10] 魏旭东 LIANG Lijie;FANG Baijun;CAO Weijie;WANG Minfang;YANG Haiping;BAI Yanliang;WANG Yu;DANG Huibing;GUO Xuejun;WANG Xige;GUO Shuli;WEI Xudong(Department of Hematology,the Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou,Henan 450008,China;Department of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China;Department of Hematology,the First People's Hospital of Pingdingshan',Pingdingshan,Henan 462500,China;Department of Hematology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China;Department of Hematology,Henan Provincial People's Hospital,Zhengzhou,Henan 450000,China;Department of Hematology,the Third People's Hospital of Zhengzhou,Zhengzhou,Henan 450000,China;Department of Hematology,the First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473003,China;Department of Hematology,Puyang Oilfield General Hospital,Puyang,Henan 457001,China;Department of Hematology,the Third Af filiated Hospital of Zhengzhou University,Zhengzhou,Henan 450015,China;Department of Hematology,Luoyang Center Hospital,Luoyang,Henan 471000,China)

机构地区：[1]郑州大学附属肿瘤医院,河南省肿瘤医院血液科,河南郑州450008 [2]郑州大学第一附属医院血液科,河南郑州450000 [3]平顶山市第一人民医院血液科,河南平顶山462500 [4]河南科技大学第一附属医院血液科,河南洛阳471000 [5]河南省人民医院血液科,河南郑州450000 [6]郑州市第三人民医院血液科,河南郑州1450000 [7]南阳医学高等专科学校第一附属医院血液科,河南南阳日473003 [8]濮阳市油田总医院血液科,河南濮阳457001 [9]郑州大学第三附属医院血液科,河南郑州450015 [10]洛阳市中心医院血液科,河南洛阳471000

出　　处：《中华实用诊断与治疗杂志》2024年第5期523-528,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 观察血液病患者应用泊沙康唑预防侵袭性真菌病(IFD)的效果,探讨预防后发生IFD突破的影响因素。方法 回顾性分析2018年10月1日—2020年12月31日河南省10家医院203例应用泊沙康唑预防IFD的血液病患者的临床资料,其中化疗患者91例,造血干细胞移植患者112例。化疗、造血干细胞移植当天或入院后出现外周血中性粒细胞计数减少(<0.5×10^(9)/L)时给予泊沙康唑口服预防IFD,记录预防治疗4 d以上或停药后7 d内确诊/临床诊断/拟诊IFD(PPP-IFD)及未确定IFD发生情况。发生PPP-IFD或未确定IFD者为IFD突破,IFD突破后启动抗真菌治疗,继续给予泊沙康唑口服或经验性联合伏立康唑、卡泊芬净、两性霉素B。比较不同年龄、性别、原发病、合并症、IFD感染史、血液病治疗方法、泊沙康唑预防时机、泊沙康唑预防疗程及中性粒细胞计数减少>2周、使用胃肠外营养等临床特征的化疗、造血干细胞移植患者IFD突破发生率。采用多因素Cox回归分析化疗、造血干细胞移植的血液病患者应用泊沙康唑预防IFD后发生IFD突破的影响因素。结果 (1)203例患者IFD突破发生率为17.73%,其中化疗患者13例,造血干细胞移植患者23例。(2)中性粒细胞计数减少≤2周(3.30%)、泊沙康唑预防疗程≥2周(3.30%)的化疗患者IFD突破发生率低于中性粒细胞计数减少>2周(10.99%)、泊沙康唑预防疗程<2周(10.99%)者(P<0.05),不同性别、年龄、泊沙康唑预防时机、化疗类型及有无合并症、IFD感染史、胃肠外营养的化疗患者IFD突破发生率比较差异均无统计学意义(P>0.05)。泊沙康唑预防疗程(HR=1.643,95%CI:0.074~2.467,P=0.027)是化疗的血液病患者泊沙康唑预防后发生IFD突破的影响因素。(3)有IFD感染史(16.07%)、糖皮质激素剂量>2 mg/(kg·d)(11.61%)、泊沙康唑预防疗程<4周(11.61%)的造血干细胞移植患者IFD突破发生率高于无IFD感染史(4.46%)、糖皮质激素�Objective To observe the efficacy of posaconazole on preventing invasive fungal disease(IFD)in patients with hematological diseases,and to investigate the influencing factors of IFD breakthrough after posaconazole prophylaxis.Methods Totally 203 patients received posaconazole to prevent IFD in 10 hospitals in Henan province from October 1,2018 to December 31,2018,among whom 91 patients received chemotherapy and 112 received hematopoietic stem cell transplantation(HSCT)for hematological diseases,and their clinical data were retrospectively analyzed.The patients were given oral posaconazole for preventing IFD on the day of chemotherapy and HSCT,or on the day of decreased absolute neutrophil count(<0.5×10^(9)/L)after admission.The occurrence of proven/probable/possible IFD(PPP-IFD)and undefined IFD was recorded after posaconazole prophylaxis over 4 d or within 7 d after discontinuation of medication.After IFD breakthrough(occurrence of PPP-IFD or undefined IFD),antifungal therapy was initiated with continuous use of oral posaconazole or combined empirical treatment with voriconazole,caspofungin,or amphotericin B.The incidences of IFD breakthrough were compared among patients with different ages,genders,primary diseases,comorbidities,history of IFD,hematological disease treatment methods,timing and course of posaconazole prophylaxis,course of decreased neutrophil count>2 weeks,and use of parenteral nutrition after chemotherapy and HSCT patients.Multivariate Cox regression analysis was conducted to identify the influencing factors of IFD breakthrough in patients undergoing chemotherapy and HSCT after posaconazole prophylaxis.Results(1)The incidence of IFD breakthrough was 17.73%,including 13 chemotherapy patients and 23 HSCT patients.(2)In chemotherapy patients,the incidences of IFD breakthrough were lower in those with course of decreased absolute neutrophil count≤2 weeks and posaconazole prophylaxis course≥2 weeks(3.30%,3.30%)than those in patients with course of decreased absolute neutrophil count>14 d and pos

关 键 词：血液病 泊沙康唑 侵袭性真菌病 化疗 造血干细胞移植 

分 类 号：R519[医药卫生—内科学]