两性霉素B治疗49例血液恶性肿瘤患者深部真菌感染分析

Outcome analysis of 49 cases of fungal infections in patients with hematologic malignancy after amphotericin B treatment

目的观察两性霉素B对血液恶性肿瘤患者深部真菌感染的临床疗效及安全性。方法49例血液恶性肿瘤患者合并真菌感染使用两性霉素B,剂量为每日0．5～1 mg/kg,用药10～61 d,中位数26 d,观察用药前及用药后1周患者症状、体征,血电解质及肝、肾功能的变化。结果两性霉素B临床总有效率为56．9%,真菌清除率42．4%,各种不良反应发生率在3．6%～24．5%,常见的不良反应依次为两性霉素B输注的畏寒、寒战、发热等全身反应,低钾血症,消化道反应,肾功能损害,肝功能损害,静脉炎。结论两性霉素B抗菌谱广,抗菌作用强,虽不良反应较为多见,只要合理用药及不良反应处理得当,大多数患者仍可耐受。

Objective To analyze the efficacy and safety of amphotericin B in the treatment of invasive fungal infections in patients with hematologic malignancy. Methods Patients with hematologic malignancy were given amphotericin B, 0.5-1.0 mg/kg per day for 10-61 days （median duration of 26 days）. The clinical findings of symptoms and signs, hepatic and renal function tests and the results of electrolytes were reviewed on Day 7. Results The overall clinical efficacy rate of amphotericin B was 56.7 %, and fungal elimination rate was 42.4%. The incidence of various adverse events ranged from 3.6% to 24.5 %. The most common adverse events were systemic reactions like rigors, chills, and fever after amphotericin infusion, hypokalemia, gastrointestinal reaction, renal impairment, hepatic impairment and phlebitis. Conclusions AmPhoteriein B is stitl a highly active, broad-spectrum antifungal agent, though the adverse events are frequently reported. However, it may be well-tolerated in most patients if it is administered properly, and the side effects are managed appropriately.