卡泊芬净、伏立康唑序贯疗法与伊曲康唑完整疗程治疗52例恶性血液病患者继发侵袭性真菌感染的疗效比较

Comparison of the effect of intravenous caspofungin followed by voriconazole tablets and itraconazole with complete period treatment for anti-invasive-fungal therapy in 52 patients with malignant hematologic disease

目的评价卡泊芬净(caspofungin)静脉注射后口服伏立康唑(voriconazole)序贯治疗与伊曲康唑(itraconazole)完整疗程两种不同经验性抗真菌治疗方法在恶性血液病患者中的疗效及安全性。方法回顾性分析无锡市人民医院2005年1月至2008年4月间52例恶性血液病继发侵袭性真菌感染患者,根据不同抗真菌治疗方法分成两组,A组(22例)采用卡泊芬净静注后伏立康唑口服序贯疗法;B组(30例)采用伊曲康唑完整疗程治疗。观察两组患者的疗效和不良反应。结果A组的总有效率为81.8%(18/22),药物相关的不良反应发生率9.1%(2/22)。B组的总有效率63.3%(19/30),不良反应发生率16.7%(5/30)。两组总有效率均较高,但有显著性差异(P<0.05),A组不良反应率显著低于B组。结论两种方案对恶性血液病继发侵袭性真菌感染的患者均有效。卡泊芬净联合伏立康唑疗法比伊曲康唑完整疗程疗法更具有疗效优势,且安全性好,不良事件发生率低。

Objective To evaluate the efficacy and safety of intravenous caspofungin followed by voriconazole tablet and itraconazole with complete period treatment for antifungal therapy of malignant hemopathie patients. Methods A retrospective analysis was employed from January 2005 to April 2008 in Wuxi People＇s Hospital. Fifty-two patients with malignant hematologic disease infected by invasive fungal were divided into 2 groups according to the different anti-invasive-fungal therapy. Patients in Group A （22 cases）were administered with intravenous caspofungi followed by vorieonazole tablet sequential therapy, patients of Group B （30 cases） were administered with itraconazole with complete period treatment. Adverse events and the efficacy were investigated. Results The overall efficacy of A group was 81.8%（18/22）, the incidence of ADR （adverse reactions rate） related to the drug was 9.1% （2/22）. The total effective rate of Group B was 63, 3 % （19/30）, the ADR was 16.7 % （5/30）. Both these two groups had high overall effective rates, but the adverse reactions occurrence of Group A was lower than that of Group B（P〈0. 05）. Conclusions Both the two regimens are effective for treating patients with malignant hematologic disease infected by invasive fungal. Caspofungin and voriconazole sequential therapy has more predominance in efficiency and safety than with itraconazole complete period treatment,the former has lower adverse reactions rates.