侵袭性真菌感染237例治疗分析

Clinical Analysis of 237 Cases of Invasive Fungal Infection

目的观察侵袭性真菌感染应用氟康唑、伊曲康唑和两性霉素B治疗的临床疗效及安全性。方法选择南方医科大学附属南方医院2002年2月至2007年2月收治的侵袭性真菌感染患者237例,单用常规剂量氟康唑107例、伊曲康唑84例、两性霉素B46例;氟康唑治疗无效者改用伊曲康唑39例和两性霉素B26例,伊曲康唑治疗无效改用两性霉素B和脂质体两性霉素B39例。结果237例侵袭性真菌感染总的治愈率和有效率分别为54.85%和72.57%。单用氟康唑治疗组的有效率显著低于伊曲康唑和两性霉素B治疗组,分别为39.25%、53.57%和56.52%(P<0.05);用氟康唑治疗无效改用伊曲康唑或两性霉素B治疗的有效率分别为76.93%和84.61%。结论伊曲康唑和两性霉素B抗真菌谱广且疗效相似,优于氟康唑;氟康唑和伊曲康唑安全性良好,而两性霉素B的不良反应发生率高。

Objective To evaluate the efficacy and safety of fluconazol, itraconazol and amphotericin B in the treatment of invasive fungal infection. Methods 237 patients with invasive fungal infection were treated with routine dose of fluconazol （107 cases）, itraconazole （84 cases） and amphoteficin B （46 cases）. 65 cases, showed no improvement on fluconazol treatment, were changed to use itraconazole or amphotericin B, and 39 cases, showed no improvement on itraconazole treatment, were changed to use amphotericin B or amphotericin B lipid. Results Total cure rate and effective rate were 54.85% and 72.57%, respectively. The effective rate of the patients used fluconazol was 39.25%, lower than those used itraconazole or amphotericin B, 53.57% and 56.52%, respectively. The effective rate of the patients changed from fluconazol to itraconazole or amphotericin B were 76.93% and 84.61% ,respectively. Conclusion The anti-fungal spectrum of itraconazole and amphotericin B are broad. The effective rates of itraconazole and amphotericin B are similar, higher than that of fluconazol. Fluconazol and itraconazol are safe, but amphotericin B has stronger side effect.