伏立康唑与艾沙康唑治疗侵袭性肺曲霉病患者的疗效比较  

Comparison of voriconazole with isavuconazole in treatment of invasive pulmonary aspergillosis

作　　者：翟建霞 赵俊歌 宋永娜 李敏 Zhai Jian-xia;Zhao Jun-ge;Song Yong-na;Li Min(The Second Ward,Department of Respiratory and Critical Care Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院呼吸与危重症医学科二病区,郑州450000

出　　处：《中国药物应用与监测》2025年第1期47-50,共4页Chinese Journal of Drug Application and Monitoring

基　　金：2021年度河南省医学科技攻关计划联合共建项目和软科学项目(LHGJ20210762)。

摘　　要：目的分析伏立康唑与艾沙康唑治疗侵袭性肺曲霉病(IPA)的疗效。方法将2021年1月至2024年1月郑州大学附属郑州中心医院收治的82例IPA患者按照随机数字表法分为伏立康唑组41例(口服伏立康唑治疗)和艾沙康唑组41例(口服艾沙康唑治疗),对比两组患者血清半乳甘露聚糖(GM)、1,3-β-D葡聚糖(BG)水平,白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)等炎症因子水平,肺总量(TLC)、一氧化碳弥散量(DLCO)、血氧饱和度(SaO_(2))等肺功能指标,临床疗效以及药物安全性。结果治疗后,艾沙康唑组GM、BG水平以及IL-6、IL-8、TNF-α等炎症因子[分别为(0.30±0.17)μg·L^(-1)、(16.15±4.32)pg·mL^(-1)、(32.88±3.06)pg·mL^(-1)、(32.06±3.92)pg·mL^(-1)、(94.31±9.37)pg·mL^(-1)]均低于伏立康唑组[分别为(0.41±0.11)μg·L^(-1)、(20.75±5.48)pg·mL^(-1)、(37.52±3.54)pg·mL^(-1)、(39.15±4.12)pg·mL^(-1)、(100.82±10.15)pg·mL^(-1)](t=3.479、4.221、6.349、7.983、3.018,均P<0.05);伏立康唑组阳性率[26.82%(11/41)]高于艾沙康唑组[9.76%(4/41)](χ^(2)=3.998,P<0.05);艾沙康唑组TLC、DLCO、SaO_(2)肺功能指标水平[分别为(75.18±4.98)%、(67.01±4.13)%、(96.17±9.12)%]均高于伏立康唑组[分别为(69.34±5.81)%、(63.52±3.17)%、(90.27±8.55)%](t=4.887、4.292、3.02,均P<0.05);两组临床总有效率比较,艾沙康唑组[95.12%(39/41)]优于伏立康唑组[78.05%(32/41)](χ^(2)=5.145,P<0.05);伏立康唑组不良反应发生率[31.71%(13/41)]高于艾沙康唑组[12.20%(5/41)](χ^(2)=4.556,P<0.05)。结论对于IPA患者的治疗,艾沙康唑的疗效优于伏立康唑,不仅可降低患者的血清BG、GM水平,缓解机体炎症反应,减轻肺功能损伤,而且耐受性更好,药物不良反应更少。Objective To compare the efficacy of voriconazole with that of isavuconazole in treatment of invasive pulmonary aspergillosis(IPA).Methods Eighty-two IPA patients admitted to Zhengzhou Central Hospital affiliated to Zhengzhou University from January 2021 to January 2024 were randomly divided into the voriconazole group(n=41,treated with oral voriconazole)and the isavuconazole group(n=41,treated with oral isavuconazole).The serum galactomannan(GM)and 1,3-β3-β-D glucan(BG)levels were compared between the two groups.Levels of inflammatory factors such as interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),lung function indexes such as total lung capacity(TLC),carbon monoxide diffusion volume(DLCO),oxygen saturation(SaO_(2)),clinical efficacy and drug safety were also compared between the two groups.Results After treatment,the levels of GM and BG,and inflammatory factors such as IL-6,IL-8 and TNF-αin the isavuconazole group((0.30±0.17)μg·L^(-1),(16.15±4.32)pg·mL^(-1),(32.88±3.06)pg·mL^(-1),(32.06±3.92)pg·mL^(-1),(94.31±9.37)pg·mL^(-1))were lower than those in the voriconazole group((0.41±0.11)μg·L^(-1),(20.75±5.48)pg·mL^(-1),(37.52±3.54)pg·mL^(-1),(39.15±4.12)pg·mL^(-1),(100.82±10.15)pg·mL^(-1))(t=3.479,4.221,6.349,7.983,3.018,all P<0.05).The positive rate of the voriconazole group(26.82%(11/41))was higher than that of the isavuconazole group(9.76%(4/41))(χ^(2)=3.998,P<0.05).TLC,DLCO and SaO_(2) lung function indexes((75.18±4.98)%,(67.01±4.13)%,(96.17±9.12)%)were higher than those in the voriconazole group((69.34±5.81)%,(63.52±3.17)%,(90.27±8.55)%)(t=4.887,4.292,3.02,all P<0.05).As for the clinical efficacy,it was better in the isavuconazole group(95.12%(39/41))than in the voriconazole group(78.05%(32/41))(χ^(2)=5.145,P<0.05).The incidence of adverse reactions in the voriconazole group(31.71%(13/41))was significantly higher than that in the isavuconazole group(12.20%(5/41))(χ^(2)=4.556,P<0.05).Conclusion For the treatment of IPA patients,the efficacy of isavucona

关 键 词：伏立康唑 艾沙康唑 肺功能 炎症因子 临床疗效 耐受性 

分 类 号：R519[医药卫生—内科学]