伏立康唑治疗粒细胞缺乏患者肺侵袭性真菌感染疗效分析

Clinical efficacy of voriconazole in treatment of neutropenia patients complicated with invasive pulmonary fungal infections

目的分析伏立康唑治疗肺侵袭性真菌感染的疗效及安全性,指导临床抗真菌感染的药物选择及治疗时机。方法调查2012年7月-2013年8月血液内科粒细胞缺乏发生肺部真菌感染住院患者共14例,所有患者均符合临床诊断标准;先给予静脉滴注伏立康唑治疗,2周后改为口服维持,观察患者体温、肺部症状及体征、肺部CT影像学变化,总结伏立康唑治疗肺部真菌感染的有效率,观察伏立康唑治疗过程中的不良反应。结果 14例肺真菌感染患者中完全缓解9例占64.3%,部分缓解3例占21.4%,无效2例,中位起效时间4d;按CTC 3.0标准14例患者发生一级不良反应共4例,发生率28.57%,其中谷丙转氨酶及谷草转氨酶升高,发生3例占21.4%,给予还原型谷胱甘肽治疗后转氨酶降至正常;全身皮肤皮疹1例占7.1%,给予口服马来酸氯苯那敏后皮疹消退,期间伏立康唑均未给予减量或停药。结论伏立康唑治疗肺侵袭性真菌感染疗效满意,不良反应发生率较低,且均在可控制范围。

OBJECTIVE To analyze the efficacy and safety of voriconazole in treatment of invasive pulmonary fungal infections so as to provide guidance for clinical use of antibiotics for treatment of fungal infections.METHODS A total of 14 neutropenia patients complicated with pulmonary fungal infections,who were hospitalized the department of hematology from Jul 2012 to Aug 2013,were enrolled in the study,all the patients conformed to the clinical diagnosis criteria;the patients were firstly given the intravenous administration of voriconazole and treated with oral administration for maintenance two week later;the body temperature,pulmonary symptoms,physical signs,and pulmonary CT imaging were observed,the effective rate of voriconazole in treatment of pulmonary fungal infections was analyzed,and the adverse reactions were observed.RESULTS Of the 14 patients with pulmonary fungal infections,9（64.3%）relieved completely,3（21.4%）relieved partially,and 2 were ineffective,with the median onset time of 4days.According to the CTC3.0 criteria,the grade I adverse reactions occurred in 4 of 14 patients with the incidence of 28.57%,there were 3（21.4%）cases with the elevated levels of alanine aminotransferase and aspartate aminotransferase,and the levels of transaminases returned to normal after the treatment with reduced glutathione.There was 1（7.1%）case of whole body skin rash,the skin rash subsided after the oral administration of chlorpheniramine maleate,and the dose of voriconazole was neither reduced nor withdrawn during the treatment.CONCLUSION Voriconazole can achieve satisfying efficacy in treatment of invasive pulmonary fungal infections,and the incidence of adverse reactions is low and in a controllable range.