米卡芬净治疗儿童恶性血液病并侵袭性真菌感染30例

Malignant Hematological Disease Combined with Invasive Fungal Infection Treated with Micafungin in 30 Children

目的探讨米卡芬净（MCM）治疗儿童恶性血液病并侵袭性真菌感染（IFI）的疗效及安全性。方法选择2007年1月-2010年1月本院儿科血液/肿瘤病房诊治的恶性血液病并IFI患儿30例。包括ALL 12例,急性髓系白血病8例,复发难治性急性白血病5例,恶性淋巴瘤2例,急性再生障碍性贫血、慢性粒细胞性白血病同胞全相合造血干细胞移植、骨髓异常增生综合征各1例。应用MCM进行治疗,MCM剂量为3 mg.kg-1.d-1,1次.d-1,静脉输注,7 d为1个疗程,治疗1~4个疗程,同时动态监测1,3β--D葡-聚糖试验（G试验）、高分辨肺CT及各脏器功能指标。结果痊愈12例,显效6例,进步5例,无效7例,总有效率60%,病死率30%。本组患儿未发现肝肾功能、血液系统等不良反应。结论恶性血液病患儿是IFI的高发人群,诊断及治疗均存在难度,对IFI高危患儿进行G试验和高分辨肺CT动态监测,及早进行拟诊IFI是治疗成功的关键,MCM在恶性血液病并IFI患儿的治疗中显示了安全、有效的抗真菌作用。

Objective To explore the clinical effects and safety of micafungin（MCM） on malignant hematological disease combined with invasive fungal infection（IFI） in children.Methods Thirty IFI children with malignant hematological disease were selected for observation from Jan.2007 to Jan.2010 in the Department of Pediatric Hematology/Oncology.Among those children,12 cases were diagnosed as ALL,8 cases with acute myeloid leukemia,5 cases with relapsed or refractory acute leukemia,2 cases with lymphoma,1 case with acute aplastic anemia,1 chronic myelocytic leukemia child followed by transplantation with ploidentical sibling donor and 1 case with myelodysplastic syndrome.All the children received treatment of MCM for IFI.A dose of MCM 3 mg·kg-1·d-1 was administered for once-daily,7 days a cause of treatment,and the children received 1 to 4 coures individually.At meanwhile 1,3-β-D glucan assay（G test）,high-resolution CT and the biochemical indexes for organs functions were kept on watch.Results In this group,12 cases were cured,6 cases turned better,5 cases improved clinically and 7 cases were invalid.The total effective rate was 60%,and the mortality was 30%.No side-effects were found in those children with MCM treatment.Conclusions Children with maligant hematological disease easily caught IFI.The diagnosis and treatment for it is quitely difficult while the mortality was quite high.The key points for successful treatment included early clinically presumed IFI with consecutive monitoring of G test as well as high-resolution CT,followed by effective antifungal drugs.MCM has reliable effects and it safe for IFI in children.