伊曲康唑对恶性血液病患者侵袭性真菌感染的疗效分析

Effect of itraconazole on treatment of invasive fungal infections in patients with hematological malignancies

目的研究伊曲康唑在治疗恶性血液病患者侵袭性真菌感染的临床疗效。方法将医院2009年5月-2011年12月收治的96例恶性血液病患者纳入研究,对于符合真菌感染拟诊病例纳入序贯治疗组(45例),符合真菌感染经验性治疗的病例纳入经验治疗组(51例),经验治疗组采用伊曲康唑静脉给药,以患者体温恢复正常为有效,序贯治疗组采用伊曲康唑序贯治疗方案,该组患者以临床症状消失为有效;治疗过程中经验治疗组有患者符合拟诊或确诊标准时,则转入序贯治疗组进行治疗,一个疗程后对两组患者进行疗效评估。结果经验治疗组的51例患者中,有9例转为拟诊病例,进行疗效评估时共有42例患者,其中有效者38例,有效率为90.48%;序贯治疗组在进行疗效评估时共有拟诊患者54例,有效51例,有效率为94.44%;所有患者中无肾功能损害发生,有4例肝功能出现异常。结论伊曲康唑在治疗恶性血液病患者侵袭性真菌感染的中确实具有明显疗效,且安全性较好,值得在临床推广,但需注意使用过程中对肝功能的监测。

OBJECTIVE To explore the clinical efficacy of itraconazole in treatment of the invasive fungal infections in the patients with hematological malignancies. METHODS A total of 96 patients with hematological malignancies who enrolled hospitals from May 2009 to Dec 2011 were involved in the study, totally 45 cases which were suspected or established the fungal infections were given the sequential treatment of itraconazole; and other 51 patients who were consistent with the empirical treatment standard were given the intravenous itraconazole only, it was regarded as normal that the body temperature returned to normal ; the sequential treatment group adopted the sequential treatment with itraconazole, and it was regarded as effective when the clinical symptoms disappeared; the patients who were in accordance with the suspected or confirmed criteria during the treatment were transferred for the sequential treatment , then the clinical efficacy of the two groups was evaluated after one course. RESULTS Among 51 patients in the empirical treatment group, there were 9 suspected patients, totally 38 out of 42 cases in the empirical group responded well to iraconazole with the effective rate of 90. 48%;while the 51 out of 54 suspected cases in the sequential treatment group responded well with the effective rate of 94.44%; there were no cases with renal dysfunction and 4 cases with liver abnormalities. CONCLUSION Itraconazole is effective and safe in the treatment of the invasive fungal infections in the patients with hematological malignancies, which is worth of the clinical promotion, but it is necessary to pay attention to the monitoring of the liver function.