伏立康唑治疗恶性血液病患者合并侵袭性真菌感染临床疗效分析

Clinical efficacy of voriconazole in treatment of invasive fungal infections in patients with hematologic malignancies

目的分析伏立康唑治疗恶性血液病患者合并侵袭性真菌感染(IFI)临床疗效和安全性。方法 88例患者予以伏立康唑抗真菌治疗,从临床表现、影像学和病原学3个方面评价疗效,并观察药物不良反应。结果 IFI发生率24.0%,其中肺部感染最多见,占68.2%;所有IFI患者发热占87.5%,60例肺部真菌感染者均出现肺部影像学改变,其中典型改变占54.5%;26例检出假丝酵母菌生长,12例检出曲霉菌属,有58例经治疗有效,总有效率为65.9%,无效12例,死亡18例,死亡率20.5%;主要不良事件是神经精神症状、视觉异常和皮疹;88例可评价病例中无因不能耐受药物相关不良事件而退出治疗。结论伏立康唑是治疗恶性血液病患者IFI的高效及安全的药物,同时其所引发的不良事件较少。

OBJECTIVE To evaluate the efficacy and safety of voriconazole in primary therapy of invasive fungal infection（IFI） in the patients with hematologic malignancies.METHODS A total of 88 patients were given voriconazole for the treatment of fungal infections,the clinical efficacy was evaluated by a global assessment of clinical manifestations,radiography,and pathology,the drug adverse reactions were observed.RESULTS The incidence rate of IFI was 24.0%,the pulmonary IFI was as one of the most common types,accounting for 68.2%,the patients with fever accounted for 77.3%of all IFI patients,all the 60 pulmonary IFI patients presented abnormal radiological characteristics,among which the typical sign in lung CT image accounted for 54.5%.Candida spp were detected in 26 patients,Aspergillus in 12 cases,58 patients were effective to the treatment with the total effective rate of 65.9%,12 cases invalid,18 cases dead,the mortality rate was 20.5%.Psychoneurosis,visual disturbances,and skin rash were considered the main drug-related Aes.No patients withdrew voriconazole treatment for the intolerable Aes.CONCLUSION Voriconazole,with less drug-related adverse incidents,is efficacious and safe in the treatment of IFI in the patients with hematologic malignancies,which is a promising alternative.