伊曲康唑口服液对急性白血病化疗后粒细胞缺乏期侵袭性真菌感染的预防作用

Preventive effect of itraconazole oral solution for invasive fungal infection in neutropenic patients with acute leukemia after chemotherapy

目的评价伊曲康唑VI服液对预防急性白血病化疗后粒细胞缺乏（粒缺）期侵袭性真菌感染（IFI）的疗效。方法回顾性分析2008年1月-2010年12月南方医院血液科收集的急性白血病化疗后伴粒缺的136例患者，将其分为伊曲康唑组（67例）和对照组（69例）。伊曲康唑组中急性非淋巴细胞白血病（ANLL）36例，急性淋巴细胞白血病（ALL）31例；对照组中ANLL30例，ALL38例，1例为急性双表型白血病（BAL）。伊曲康唑组化疗后粒缺期间给予伊曲康唑口服液，持续至中性粒细胞计数〉0．5×10^9／L，或是体温正常且影像学无IFI改变时停用。采用SPSS13．0软件分析两组IFI的发生率及临床特点。计数资料采用PearsonX。检验，正态分布的计量资料采用t检验，偏态分布的数据采用Mann—WhitneyU检验。结果伊曲康唑组12例发生IFI，发生率为17．9％（12／67），对照组32例发生IFI，发生率为46．4％（32／69），两组IFI发生率比较差异有统计学意义（X^2=12．59，P〈0．01）。伊曲康唑组中ANLL患者IFI发生率（6／36，16．7％）低于对照组中ANLL患者的发生率（17／30，56．7％）（X^2=11．53，P〈0．01）。伊曲康唑组女性患者IFI发生率（3／35，8．6％）低于男性（9／32，28．1％）（X^2=4．35，P〈0．05），同时也低于对照组中女性患者IFI发生率（17／38，44．7％）（X^2=11．98，P〈0．01）。结论急性白血病化疗后粒缺期患者预防性口服伊曲康唑可以有效降低IFI的发生，对于急性非淋巴细胞白血病女性患者，疗效更加显著。

Objective To evaluate the efficacy of itraconazole oral solution for prevention of invasive fungal infection （IFI） in neutropenic patients with acute leukemia after chemotherapy. Methods Clinical data of 136 neutropenic patients with acute leukemia after chemotherapy at the Department of Hematology, Nanfang Hospital from January 2008 to December 2010 were retrospectively analyzed. Patients were divided into itraconazole group （n = 67） and control group （n = 69）. There were 36 patients with acute nonlymphocytic leukemia （ANLL）, 31 with acute lymphoblastic leukemia （ALL） in itraconazole group; while in control group, there were 30 patients with ANLL, 38 with ALL and 1 with biphenotypie acute leukaemia （BAL）. Patients in itraconazole group received intraconazole after chemotherapy until the neutrophil count was increased to 0.5×10^9/L or the body temperature returned to normal and without any imaging evidence of IFI. The incidence of IFI and clinical features were compared between the groups using SPSS 13.0 software. Pearson X^2 test was used for nominal variables, for measurement data, t （normal distribution） or Mann-Whitney U （skewed distribution） test were used. Results There were 12 cases （ 17.9% ） suffering from IFI in itraconazole group and 32 cases （46.4%） in the control group （X^2 = 12.59, P 〈 0.01 ）. For ANLL patients, the incidence of IFI in itraeonazole group was significantly lower than that in control group （ 16.7% vs. 56.7% , X^2 = 11.53, P 〈0.01 ）. In itraconazole group, the incidence of IFI in female patients was significantly lower than that in male patients （8.6% vs. 28. 1% , X^2 = 4.35, P 〈 0. 05）. And for the female patients, the incidence of IFI in itraeonazole group was significantly lower than that in the control group （ 8.6% vs. 44.7%, X^2 = 11.98, P 〈 0.01 ）. Conclusion Itranconzole oral solution can effectively prevent IFI in neutropenic patients with acute leukemia after chemotherapy, especially for the female patients with ANLL.