两性霉素B脂质体挽救性治疗80例血液病患者侵袭性真菌病临床疗效分析  

Clinical efficacy and safety of liposomal amphotericin B in the salvage treatment of invasive fungal disease in patients with hematological diseases

作　　者：吴源兵 姜珊珊 吴雅雪 刘彬 景雨童 包海燕[2] 马骁[2] 吴德沛[2] 胡晓慧 Wu Yuanbing;Jiang Shanshan;Wu Yaxue;Liu Bin;Jing Yutong;Bao Haiyan;Ma Xiao;Wu Depei;HuXiaohui(Department of Hematology,The Hospital of Suzhou Hongci Hematology,Suzhou 215000,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,Suzhou 215000,China)

机构地区：[1]苏州弘慈血液病医院血液科,苏州215000 [2]苏州大学附属第一医院血液科,江苏省血液病研究所,国家血液系统疾病临床医学研究中心,苏州215000

出　　处：《中华血液学杂志》2024年第7期666-671,共6页Chinese Journal of Hematology

基　　金：苏州工业园区和合远达血液创新研究院项目(H221084);临床专科人才专业能力创新应用科研项目(RCLX2315016)。

摘　　要：目的探究两性霉素B脂质体(Liposomal amphotericin B,L-AmB)在血液病患者中挽救性治疗侵袭性真菌病(invasive fungal disease,IFD)的疗效及安全性。方法回顾性收集既往抗真菌治疗失败后2023年6月至2023年12月期间于苏州弘慈血液病医院血液科接受L-AmB治疗的80例血液病患者资料。统计患者基本信息、临床疗效,应用Logistic回归分析影响L-AmB疗效的因素。结果80例血液病患者中,确诊IFD 9例(11.2%),临床诊断IFD 43例(53.8%),拟诊IFD 28例(35.0%)。L-AmB挽救性治疗有效率为77.5%,中位每日剂量3(1~5)mg·kg^(-1)·d^(-1),中位用药疗程14(8,25)d。多因素Logistic回归分析显示:疾病缓解状态(OR=4.337,95%CI 1.167~16.122,P=0.029)和用药疗程(OR=1.127,95%CI 1.029~1.234,P=0.010)是影响L-AmB疗效的独立因素。L-AmB相关输液反应包括发热和寒战(5.0%)。低钾血症发生率为28.8%,主要为1~2级。肾毒性发生率为11.3%,主要为1~2级。结论L-AmB治疗既往抗真菌治疗不耐受或无效的IFD患者安全有效,不良反应率低。Objective:To investigate the efficacy and safety of liposomal amphotericin B(L-AmB)for the salvage treatment of invasive fungal disease(IFD)in patients with hematological diseases.Methods:Data were retrospectively collected from 80 patients with hematological issues treated with L-AmB between June 2023 and December 2023 after failure of previous antifungal therapy.Baseline patient information,clinical efficacy,and factors affecting the efficacy of L-AmB were analyzed by logistic regression.Moreover,adverse effects associated with L-AmB were evaluated.Results:Among the 80 patients,9(11.2%)had proven IFD,43(53.8%)had probable IFD,and 28(35.0%)had possible IFD.The efficacy rate of L-AmB salvage therapy for IFD was 77.5%,with a median daily dose of 3(range:1-5)mg·kg^(-1)·d^(-1) and a median dosing course of 14(range:8-25)days.Multivariate logistic regression analysis showed that the disease remission status(OR=4.337,95%CI 1.167-16.122,P=0.029)and duration of medication(OR=1.127,95%CI 1.029-1.234,P=0.010)were independent factors affecting the efficacy of L-AmB.The incidence of infusion reactions associated with L-AmB,including fever and chills,was 5.0%.The incidence of hypokalemia was 28.8%(predominantly grades 1-2),and the incidence of nephrotoxicity was 11.3%(predominantly grades 1-2).Conclusion:L-AmB is safe and effective in the treatment of patients with IFD who are intolerant to or who have experienced no effect of previous antifungal therapy,with a low rate of adverse reactions.

关 键 词：两性霉素B脂质体 血液病 侵袭性真菌病 

分 类 号：R552[医药卫生—血液循环系统疾病] R519[医药卫生—内科学]