卡泊芬净联合伏立康唑治疗恶性血液病继发侵袭性真菌感染临床研究

Caspofungin Combined with Voriconazole for Invasive Fungal Infections of Secondary Malignant Blood Disease

目的探讨卡泊芬净联合伏立康唑治疗恶性血液病继发侵袭性真菌感染的临床疗效,并总结护理要点。方法选择医院2012年1月至2015年4月收治的恶性血液病合并真菌感染患者52例,随机分为观察组和对照组,各26例。对照组采用伊曲康唑治疗,观察组加用卡泊芬净治疗,两组患者均给予相应护理。治疗10周后,比较两组患者的临床疗效,检测治疗前后血细菌与真菌培养情况、干扰素(IFN-γ)和白细胞介素(IL)-10表达水平,记录不良反应的发生情况。结果治疗后,观察组总有效率为89.46%,显著高于对照组的73.08%,差异有统计学意义(P<0.05)。与治疗前比较,观察组患者念珠菌、曲霉菌、隐球菌及其他真菌分布比例均降低(P<0.05),对照组患者念珠菌及曲霉菌分布比例降低(P<0.05);观察组念珠菌及曲霉菌分布比例显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者IFN-γ/IL-10比值均升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。观察组患者皮疹、恶心及转氨酶升高发生率与对照组水平相当,差异无统计学意义(P>0.05),视觉异常发病率为7.69%,高于对照组,差异有统计学意义(P<0.05)。结论卡泊芬净联合伏立康唑治疗恶性血液病继发侵袭性真菌感染临床疗效好,能提高对念珠菌及曲霉菌的清除率,改善患者免疫功能,配合适当的护理能增强患者依从性,值得临床推广。

Objective To observe the clinical efficacy of caspofungin combined with voriconazole in treating invasive fungal infection of secondary malignant blood disease, and to summarize the nursing points. M etho ds 52 cases of patients with malignant hematological diseases complicated with fungal infection from January 2012 to April 2015 were randomly divided into observation group and control group, 26 cases in each group. The control group was treated with itraconazole, the observation group was added with caspofungin. The two groups were given corresponding nursing. After 10 weeks of treatment, the clinical efficacy of the two groups were compared, the blood bacterial and fungal cultures, the IFN- gamma and IL- 10 expression levels were tested before and after the treatment, the occurrence rate of adverse reactions were recorded. Results After treatment, the total effective rate of the observation group was89. 46%, which was significantly higher than 73. 08% in the control group（ P〈0. 05）. Compared with before treatment, the ratios of candida, aspergillus, cryptococcus and other fungal distribution in the observation group were decreased（ P〈0. 05）, and the ratios of candida and aspergillus distribution decreased in the control group（ P〈0. 05）; the ratios of candida and aspergillus distribution of the observation group were significantly lower than the control group with statistical significance（ P〈0. 05）. After treatment, the IFN- gamma / IL- 10 ratio of the two groups increased, and the observation group increased more than the control group, the difference was statistically significant（ P〈0. 05）. The incidence rates of skin rash, nausea and aminotransferase increased in the observation group had no statistically significant difference with the control group（ P〉0. 05）; the incidence of visual abnormality was 7. 69% in the observation group, which was higher than the control group, the difference was statistically significant（ P〈0. 05）. Co nclusio n Caspofungin combined with voriconazole for invasive fungal infection of malignant blood disease secondary has better clinical efficacy, can improve the clearance rate of candida and aspergillus, improve the patients′ immune; proper nursing care can enhance the compliance of patients,which is worthy of clinical promotion.