伏立康唑预防血液病患者侵袭性真菌感染的疗效与安全性

The efficacy and safety of voriconazole as antifungal prophylaxis of invasive fungal infection for hematology patients

目的评价伏立康唑预防血液病患者化疗或造血干细胞移植(HSCT)后侵袭性真菌感染的有效性及安全性。方法检索Cochrane图书馆、Medline、Em-base、Pubmed、CBM、CNKI、维普、万方等文献数据库,用RevMan 5.1进行meta分析。结果纳入研究4项,共1372例患者,伏立康唑组的真菌感染发生率、曲霉感染率分别低于氟康唑组、对照组;而总死亡率、念珠菌感染率与对照组无显著性差异;伏立康唑的胃肠道不良反应发生率低于伊曲康唑,视觉障碍和肝功异常发生率高于伊曲康唑。结论伏立康唑预防血液病患者化疗或HSCT后侵袭性真菌感染的总体疗效优于氟康唑,与伊曲康唑相当,在预防侵袭性曲霉感染中优于氟康唑和伊曲康唑,但应警惕其引起视觉障碍和肝功异常。

Objective To estimate the efficacy azole as antifungal prophylaxis of invasive fungal and safety of voricon- infection （ IFI ） for He- matology patients and hematopoietic stem cell transplant recipients. Methods Cochrane library, Medline, Embase, Pubmed, CBM data- base, CNKI, VIP database, and Wanfang database. The meta analy- sis were performed by RevMan 5. 1. Results Four literatures were included （ n = 1372）. The results indicated that there was a trend to lower IFI rate in voriconazole than fluconazole and lower AspergiUus spp. infection rate in voriconazole than control groups. The overall mortality and candidiasis spp. infection rate of voriconazole are not sig- nificant different from control groups. The rate of gastrointestinal ad- verse reaction of voriconazole is lower than itraconazole, while the rates of vision disorders and liver disfunction are higher than itracon- azole, respectively. Conclusion The efficacy of voriconazole as anti- fungal prophylaxis of invasive fungal infection for hematology patients and hematopoietic stem cell transplant recipients is better than flucon- azole, and equivalent with itraconazole. Voriconazole seems superior to fluconazole and itraconazole in preventing Aspergillus spp. infec- tions. And we should be cautious about its adverse reactions of vision disorders and liver disfunction.