恶性血液病合并侵袭性真菌感染76例临床观察

The clinical study of invasive fungal infection in 76 cases of hematologic diseases

目的探讨恶性血液病合并侵袭性真菌感染（IFI）的易感因素、临床特点、疗效和不良反应。方法回顾性分析76例恶性血液病合并IFI患者的易感因素、临床特点，比较伊曲康唑与两性霉素B的疗效及安全性。结果76例恶性血液病合并IFI患者应用广谱抗生素者68例（89．5％），化疗2个疗程以上者64例（84．2％），中性粒细胞缺乏者43例（56．6％），长期应用糖皮质激素者34例（44．7％），中心或外周静脉置管者27例（35．5％）。伊曲康唑和两性霉素B治疗恶性血液病合并IFI的总有效率为60．5％和61．5％（P=0．929）；两组间不良反应对比只在低钾血症方面有差异（14．0％比42．4％，P=0．005）。结论化疗、应用广谱抗生素、中性粒细胞缺乏等是恶性血液病合并IFI的易感因素。伊曲康唑治疗恶性血液病IFI疗效与两性霉素B相当，但不良反应较少且轻微。

Objective To investigate the risk factors, clinical features, efficacy and adverse reactions in patients of hematologic diseases with invasive fungal infections （IFI）. Methods The risk factors and clinical features were retrospectively analyzed to compare the efficacy and safety of itraconazole with amphotericin B in treatment of IFI in 76 patients with hematologic diseases. Results Of the 76 patients, 68 （89.5%） used broad-spectrum antibiotics, 64 （84.2%） were treated with more than 2 courses chemotherapy, 43 （56. 6% ） were under agranulocytosis, 34 （44. 7% ） were using glucocorticoid for long terms, 27 （35.5%） were with peripheral or central venous catheter. The overall effective rates of itraconazole and amphotericin B were 60. 5% and 61.5% respectively （P = 0. 929）. There was a significant difference between itraconazole and amphotericin B in hypokalemia （ 14. 0% vs 42. 4%, P = 0. 005 ） while no other differences in adverse reactions were found. Conclusions The risk factors of patients in hematologic diseases with IFI include chemotherapy, using broad septum antibiotics and agranulocysis. The therapeutic effect of itraconazole and amphotericin B in treatment of IFI is similar. The adverse reactions of itraconazole is less and slighter than amphotericin B.