卡泊芬净与米卡芬净治疗重症侵袭性真菌感染的临床疗效与药物利用评价

Clinical effectiveness and utilization review of caspofungin and micafungin in treatment of invasive fungal infections in critical patients

目的探讨卡泊芬净和米卡芬净治疗重症侵袭性真菌感染(invasive fungal infections,IFI)患者的临床疗效,评价药物利用。方法随机抽取四川省人民医院2009年1月至2011年12月分别经卡泊芬净和米卡芬净治疗的IFI病例各40例,分析评价卡泊芬净和米卡芬净治疗IFI的疗效、不良反应及药物利用情况。结果治疗总有效率卡泊芬净组为57.5%,米卡芬净组为55.0%,差异无统计学意义(P>0.05);两组首选治疗有效率均远高于三唑类(如氟康唑、伊曲康唑)、多烯类(如两性霉素B及其脂质体)治疗无效或不能耐受而进行的挽救治疗有效率,差异有统计学意义(P<0.05);不良反应发生率卡泊芬净组高于米卡芬净组,但差异无统计学意义(P>0.05);药物利用指数(DUI)卡泊芬净为0.985,米卡芬净为1.000,使用基本合理;日用药金额卡泊芬净为1942.04元/天,米卡芬净为1260.00元/天。结论卡泊芬净和米卡芬净治疗重症IFI的疗效相当,首选二者治疗的有效率均高于挽救治疗;二者不良反应发生率相近;DUI≤1.0,为合理用药。二者在疗效和不良反应相当的情况下,从经济学角度考虑米卡芬净更具优势。

Objective To investigate the effectiveness of caspofungin and micafungin in the treatments of invasive fungal in- fections （IFI） in critical patients and evaluate utilization of the drugs. Methods We randomly sampled 80 IFI patients who were trea- ted in our hospital during the period from January 2009 to December 2011. In these patients,40 cases were treated with caspofungin, and another 40 cases with micafangin. The effectiveness, adverse reactions and utilization of these drugs were evaluated. Results There was no significant difference of effective rate between the two drug groups （57.50% and 55.0% respectively）. However, the effective rates of the two drugs used as the first treatment option was significantly higher than they used as rescue therapeutic agents（ P 〈 O. 05 ） after invalid effect or drug intolerance occurred by using triazole fungicides such as flnconazole and itraeonazole or alkenes such as am- photericin B and its liposome. The adverse reaction rate of caspofungin was higher than that of micafungin, but the difference did not reach statistically significant. The drug utilization index（DUI） of caspofungin was O. 985 and micafungin was 1. O0 ,respectively. Moreo- ver, the price of caspofungin was 1942.04 yuan per day and micafungin 1260.00 yuan per day, respectively. Conclusions The effec- tive and adverse reaction rate of the two drugs was similar in the treatment of invasive fungal infection in critical patients. However, the drugs preferred to be used as the first treatment option. Since the price of mieafungin is cheaper than that of caspofungin, the former may have more advantages than the later for clinical applications.