两性霉素B与卡泊芬净及伊曲康唑治疗恶性血液病患者侵入性真菌感染疗效比较

Efficacies of amphotericin B and caspofungin combined with itraconazole in treatment of invasive fungal infections in patients with hematologic malignancies:a comparative study

目的评价两性霉素B完整疗程与卡泊芬净静脉注射后口服伊曲康唑口服液序贯治疗的疗效及安全性。方法回顾性分析绍兴市人民医院2008年1月-2012年1月收治的恶性血液病继发侵入性真菌感染68例患者,根据不同抗真菌治疗方法分成两组,A组35例采用完整疗程两性霉素B针,B组33例采用卡泊芬净静脉注射后口服伊曲康唑口服液序贯治疗,评估两组患者的疗效、不良反应及抗菌药物费用等。结果 A组35例患者中共25例有效,总有效率71.42%,B组33例患者中共25例有效,总有效率75.75%,两组均有较高疗效,差异无统计学意义,严重输液反应A组占31.34%、B组为6.06%,肝肾功能损伤A组51.43%、B组为18.18%,严重低钾血症A组60.00%、B组为9.09%,A组治疗费用平均约为4200元、B组治疗费用平均约为43 000元,A组严重不良反应明显高于B组,但抗真菌药物费用显著低于B组。结论两种治疗方案对侵入性真菌感染均有较好疗效,而两性霉素治疗费用低廉,只要注意预防并及时处理不良反应,多数患者可长期安全使用。

OBJECTIVE To evaluate the efficacy and safety of the complete course of amphotericin B and the intravenous injection of caspofungin with oral administration of itraconazole. METHODS A total of 68 cases of hematologic malignancies patients with secondary invasive fungal infections, who were treated in the hospital from Jan 2008 to Jan 2012, were recruited and divided into two groups according to the antifungal therapy; the group A with 35 cases was treated with complete course of amphotericin B, while the group B with 33 cases was given the intravenous injection of caspofungin, followed by oral administration of itraconazole, then the efficacy, adverse reactions,and cost of antifungal agents were estimated. RESULTS Of totally 35 cases in %he group A, 25 cases were effective with the total effective rate of 71.42M , and 25 of 33 cases in the group B were effective with the effective rate of 75. 75% with good clinical efficacy in both groups, the difference was not significant. The incidence of severe adverse reactions of transfusion was 31. 34% in the group A, 6.065 in the group B% the incidence of damage of liver and renal function was 51.43% in the group A, 18.18M in the group B% the incidence of serious hypokalemia was 60.00% in the group A, 9.09% in the group B; the mean cost of antifungal therapy was 4200 yuan in the group A, 43 000 yuan in the group B; the incidence of the severe adverse reactions of the group A was significantly higher than that of the group B, but the cost of antifungal therapy of the group A was significantly less than that of the group B. CONCLUSION Both treatment regimens can achieve good clinical efficacy in treatment of invasive fungal infections, the treatment with amphotericin B is cheap, and most of the patients can use permanently as long as they pay attention to the prevention and timely treatment of adverse reactions.