血液病患者肺部侵袭性真菌感染不同治疗方法的有效性研究

Efficacies of different therapies in treatment of hematopathy patients with pulmonary invasive fungal infections

目的研究血液科病房(1,3)-β-D葡聚糖检测(G试验)或血清半乳甘露聚糖检测(GM试验)阳性住院患者宿主因素和临床特征,对比分析诊断驱动治疗和经验治疗在血液病患者合并侵袭性真菌病(IFD)时的有效性。方法将2012年7月-2013年5月可疑真菌感染的血液科G试验和GM试验,结果阳性的28例患者纳入研究,其中接受经验性治疗患者10例,设为经验治疗组,接受诊断驱动治疗患者18例,设为诊断驱动治疗组,对比两组患者的治疗有效性;应用SPSS19.0软件对数据进行统计分析。结果抗真菌治疗有效率为82.14%,其中经验性治疗患者为70.00%,诊断驱动治疗患者为88.89%;诊断驱动治疗组粒细胞缺乏>10d的患者比例明显低于经验治疗组(P<0.05);在细胞毒化疗、免疫受抑、肺部感染及治疗用药两组差异无统计学意义。结论 G试验和GM试验有助于肺部IFD的早期诊断和治疗方案的选择,诊断驱动治疗和经验治疗对于IFD均有重要价值。

OBJECTIVE To explore the host factors and clinical characteristics of the hospitalized patients of hematology department who were positive for serum（1,3）-beta-D-glucan antigen test（G test）or galactomannan assay（GM assay）and observe the efficacies of diagnostic-driven therapy and empirical therapy in treatment of the hematological diseases patients complicated with invasive fungal disease（IFD）.METHODS The patients with suspected fungal infections who were hospitalized the hematology department from Jul 2012 to May 2013 were enrolled in the study,then the blood specimens were collected from the subjects for G test and GM assay,and 28 subjects who showed positive results were finally recruited.Of the 28 subjects,10received the empirical therapy and were assigned as the empirical therapy group,and 18 received the diagnostic-driven therapy group and were set as the diagnostic-driven therapy group.The effectiveness of treatment was observed and compared between the two groups,and the statistical analysis of data was performed with the use of SPSS19.0software.RESULTS The effective rate of anti-fungal therapy was 82.14%,the effective rate of the empirical therapy was 70.00%,and the effective rate of the diagnostic-driven therapy was 88.89%;however,the proportion of the patients with neutropenia more then10 days was significantly lower in the diagnostic-driven therapy group than in the empirical therapy group（P〈0.05）.There was no significant difference in the cytotoxic chemotherapy,inhibition of immune,pulmonary infection,or use of antifungal drugs.CONCLUSIONThe G test and GM assay may be conducive to the early diagnosis of pulmonary IFD as well as the selection of therapy.The diagnostic-driven therapy and empirical therapy have significant value for the IFD.