卡泊芬净治疗老年COPD患者侵袭性肺部真菌感染36例临床分析

Clinical analysis of caspofungin in the treatment of invasive fungal infection in old COPD patients

目的观察老年COPD患者应用卡泊芬净治疗侵袭性真菌感染（IFI）的疗效与安全性。方法回顾分析本院老年临床医学部呼吸内科诊断为IFI并接受卡泊芬净治疗的COPD患者的临床资料。结果2009年10月～2010年12月共36例COPD患者接受了卡泊芬净治疗，确诊4例，包括念珠菌菌血症2例（光滑念珠菌1例，热带念珠菌1例），肺IFI2例，为曲霉菌；临床诊断20例，其中曲霉菌15N，白念珠菌5例；拟诊12例，包括白念珠菌6例，光滑念珠菌2例，近平滑念珠菌2例，曲霉菌2例。卡泊芬净的疗程（16．5±6．5）d，痊愈＋显效的总有效率72．2％，进步22．2％，无效5．6％。治疗过程中未发现与卡泊芬净有关的不良反应。结论卡泊芬净治疗老年COPD患者合并IFI有效且安全。

Objective To evaluate the effect and safety of caspofungin in the treatment of invasive fungal infection （IFI） in old COPD patients. Methods A retrospective analysis of the clinical data was conducted for 36 old COPD patients with IFI and treated with caspofungin in elderly clinical respiratory department. Results From October 2009 to December 2010, 36 COPD patients with IFI were treated with caspofungin. Four patients were confirmed cases, including 2 candidemia （1 Candida glabrata, 1 C. tropicalis）, 2 pulmonary IFI （Aspergillus spp.）. 20 clinical diagnosis cases consisted of 15 Aspergillus and 5 C. albicans spp. There were 12 probable cases, including 6 C. albicans, 1 C. glabrata, 2 C. parapsilosis and 2 Aspergillus. The mean treatment course of caspofungin was （16.5 ± 6.5）d. The overall effective rate was 72.2%. No drug-related side effect or adverse event appeared. Conclusion Caspofungin is likely to be an effective and safe treatment for IFI in old COPD patients.