卡泊芬净治疗血液肿瘤合并侵袭性真菌感染64例

Clinical study of 64 patients with invasive fungal infection in hemopathic neoplasms treated with caspofungin

目的分析卡泊芬净治疗血液肿瘤并发侵袭性真菌感染（IFI）的疗效及安全性。方法回顾性分析2007年1月至2009年2月应用卡泊芬净治疗血液肿瘤并发IFI疗程≥7d的64例患者，应用SPSS13．0软件包分析卡泊芬净治疗IFI的疗效、影响因素及安全性。结果64例疗效可评价的病例中，总有效率为54．7％（35／64），确诊组、临床诊断组和拟诊组的有效率分别为66．7％（2／3）、54．9％（28／51）、60．0％（6／10），各组间比较差异无统计学意义（P〉0．05）。发热病例中位生效时间为1（1-10）d。体温正常患者肺部阴影开始缩小的中位时间12．5（2～30）d。年龄、检出真菌、中性粒细胞（ANC）绝对值〈0．5×10^9／L持续时间、接受移植、移植物抗宿主病（GVHD）状态、使用免疫抑制剂、影像学表现、卡泊芬净负荷量及是否为挽救性治疗等各组间比较差异无统计学意义（P值均〉0．05）。不良反应发生率低且为可逆转性。结论卡泊芬净经验性或挽救性治疗IFI的效果较好，不受免疫状态、ANC数量及有无影像学变化的影响，且不良反应小。

Objective To study the efficacy and safety of caspofungin for the invasive fungal infection in hematopathic neoplasms patients. Methods The retrospective study of efficacy, influencing factors and adverse reaction in 64 patients with hematopathic neoplasms have been treated with capofungin from January 2007 to February 2009. The SPSS13.0 software was used for statistic analysis. Results The overall efficacy in 64 patients was 54.7 %.The median of effective time for patients with fever and non-fever were 1（1-10） day and 12.5（2-30） days, respectively. There were no significant difference in age, detection of fungus, duration time of ncutropenia, hematopoietic stem cell transplant, graft versus host disease, immunoppressive agents, CT scans, loading dose of caspofungin and salvage therapy between two groups. Drug-related toxicities was low and reversible. Conclusion This study strongly supported caspofungin as an option for empiric and salvage antifungal therapy, and therapeutic effect of caspofungin was not influenced by immune state, neutrophils and CT scans, drug-related toxicities was low.