伏立康唑早期经验性治疗急性白血病患儿肺部真菌感染的临床分析

Clinical analysis of voriconazole in early empirical treatment of invasive pulmonary fungal infections in children with acute leukemia

目的观察伏立康唑早期经验性治疗儿童急性白血病合并侵袭性肺部真菌感染(IPFI)的疗效及安全性。方法回顾性分析2011年1月-2012年6月收治的38例急性白血病合并侵袭性肺部真菌感染患儿的临床资料,根据临床表现及实验室检查,所有患儿在均达到临床拟诊标准时给予伏立康唑早期经验性抗真菌治疗,依据临床疗效标准综合评价该药物的疗效及安全性。结果 38例患儿在治疗结束时,症状、体征及影像学异常均明显好转;在治疗过程中,有8例(21.1%)出现转氨酶不同程度的升高,有2例(5.3%)出现总胆红素升高,5例(13.2%)出现低钾血症,2例(5.3%)出现视觉异常,经对症治疗后均恢复正常,未出现严重并发症而停药现象。结论伏立康唑作为早期经验性治疗儿童急性白血病合并侵袭性肺部真菌感染的一线药物,安全有效。

OBJECTIVE To investigate the clinical efficacy and security of voriconazole in the early empirical treat-ment of invasive pulmonary fungal infections （IPFIs） in children with acute leukemia. METHODS A total of 38children with acute leukemia complicated by IPFIs who were treated with voriconazole from Jan 2011 to Jun 2012were retrospectively analyzed. According to the clinical manifestation and laboratory examination, all the childrenwho met the clinical standard were treated with voriconazole in the early stage. The efficacy and safety of voricon-azole were comprehensively evaluated according to clinical evaluation criteria. RESULTS At the end of treatment ,the symptoms, sign and imaging abnormalities of 38 patients were significantly improved. During the course oftreatment, there were eight patients（21. 1 %） getting elevated transaminases, two patients （5. 3%） getting elevatedbilirubin, five patients （13, 2%） getting hypokalemia and two patients （5. 3%）getting visual disturbances, and allthese cases recovered after the symtomatic treatment. CONCLUSION Voriconazole,as the primary choice for theearly empirical treatment of invasive pulmonary fungal infections, is safe and effective.