卡泊芬净治疗血液病患者侵袭性真菌感染的临床观察

Caspofungin in Treatment of Invasive Fungal Infection among Patients with Hematologic Diseases:A Clinical Observation

目的观察卡泊芬净治疗血液病患者侵袭性真菌感染（IFI）的疗效和安全性。方法入选天津医科大学总医院血液科2007年6月-2009年3月80例血液病并发IFI患者,给予静脉卡泊芬净,第1天单次70 mg负荷剂量,随后每天50 mg,疗程7-21 d;根据临床和微生物学标准,综合评价该药疗效,并观察其安全性。结果 80例IFI患者确诊3例（3.8%）、临床诊断68例（85.0%）、拟诊9例（11.3%）,感染部位以肺部为主62例（77.5%）;其他部位18例（22.5%）,包括胃肠道、口腔、鼻面部等,80例感染者13例有真菌学依据,其中白色假丝酵母菌6例,光滑假丝酵母菌3例,曲霉菌属感染4例,G试验阳性者37例;有胸部影像学改变者68例,其中新月征1例,余为磨玻璃密度影或多发斑片状影;卡泊芬净治疗有效50例,总有效率62.5%;13例患者血或痰培养出真菌,其中8例获得真菌清除,真菌清除率为61.5%,无明显不良反应。结论卡泊芬净是治疗血液病患者IFI的有效安全药物。

OBJECTIVE To investigate the efficacy and safety of caspofungin in treatment of invasive fungal infection（IFI） among the patients with hematological diseases.METHODS Eighty patients with blood diseases and IFI diagnosed from Jun 2007 to Mar 2009 were selected into this study.They were treated for their IFI with caspofungin in a dose of 70mg on the first day and then 50mg each day on the next（7-21）days.RESULTS Three cases were diagnosed as（3.8%） confirmed,68（85.0%） probable and 9（11.3%） possible IFIs.The lower respiratory tract infection was found in 62 cases（77.5%）;gastrointestinal tract,buccal cavity and other parts infections in 18 cases（22.5%）.Mycological evidence was found in 13 cases,including 6 Canidia albicans,3 C.glabratas and 4 Aspergillus strains.G-test was positive in 37 cases.Radiological changes were found in 68 cases,among whom Air-crescent sign was found in 1 case,and others mainly manifested multifocal nodular lesions.Fifty cases showed good response（62.5%）;13 patients were applicable for microbiological evaluation,among whom,61.5% responded to completely to the treatment.CONCLUSIONS Caspofungin is effective and safe in the treatment of invasive fungal infection among the patients with hematological diseases.