米卡芬净与伊曲康唑治疗多发性骨髓瘤并发侵袭性真菌病的疗效和成本分析

A comparative study of efficacy and cost-effectiveness of micafungin and itraconazole in the treatment of multiple myeloma with invasive fungal disease

目的 比较米卡芬净与伊曲康唑在多发性骨髓瘤并发侵袭性真菌病（IFD）病例治疗中的疗效及成本.方法 采用回顾性分析方法,入选2010年1月～2012年11月我科发生侵袭性真菌病的37例多发性骨髓瘤患者的临床资料.对比分析米卡芬净治疗组与伊曲康唑治疗组两组患者的疗效、治疗时间、治疗成本及不良反应.结果 米卡芬净组17例,伊曲康唑组20例,米卡芬净组治疗有效率为76.46％ （13/17）,伊曲康唑组治疗有效率70％ （14/20）,差异无统计学意义（P=0.42 ＞0.05）.米卡芬净组2例发生消化道不适反应.伊曲康唑组3例发生消化道不适反应,2例低钾血症并消化道不适反应;3例患者出现药物性肾功能损害,l例停药后肾功能恢复,2例出现急性肾功能损害.米卡芬净组不良反应发生率为11.76％ （2/17）,伊曲康唑不良发生率为40％ （8/20）,两组差异有统计学意义（P＜0.05）.以治疗第14天总有效率作为疗效判断标准,米卡芬净组和伊曲康唑组成本疗效比分别为263.73和289.11.结论 米卡芬净与伊曲康唑对骨髓瘤合并IFD的治疗有效率差异无统计学意义,不良反应差异有统计学意义,前者成本效益比优于后者.

Objective In order to compare the efficacy and cost-effectiveness of micafungin and itraconazole in the treatment of multiple myeloma with invasive fungal disease. Methods We restrospectively analyzed the clinical data of 37 multiple myeloma pa- tients with invasive fungal disease. Then we analyzed the efficacy of antifungal therapy, treatment time, costs, and the adverse reac- tions. Results Seventeen patients were treated with mieafungin, and 20 patients were treated with itraconazole. The micafungin group had higher effective rate 76.46% （ 13/17 ） vs 70% （14/20）, （ P = 0.42 〉 0.05 ）. In micafungin group ,2 patients occurred gastrointestinal reaction. In itraconazole group, 3 patients occurred digestive discomfort reaction , 2 patients occurred hypokalemia and digestive discomfort reaction, 3 patients occurred drug-induced renal impairment, 1 patient~ renal function recovered after the drug was stopped, other 2 patients turned up with acute renal damage. The micafungin group had a lower adverse reactions was 11. 76% （2/17） vs 40% （ 8/20）, （ P 〈 0.05 ）. The C/Es were 263.73 and 289.11 in micafungin group, itraconazole group, respec- tively. Conclusions In the treatment of multiple myeloma with IFD, The effective rate of treatment between itraconazole and micaf- ungin had no statistical difference but the adverse reactions had significant difference, the cost-effectiveness ratio of micafungin is lower than itraconazole.