泊沙康唑初级预防在急性髓系白血病化疗期间的作用

Primary antifungal prophylaxis with posaconazole plays a pivotal role during chemotherapy of acute myeloid leukemia

目的研究泊沙康唑初级预防急性髓系白血病（AML）诱导化疗期侵袭性真菌感染（IFI）的发生率及静脉抗真菌药物使用率。方法回顾性分析2014年2月至2016年1月≥15岁初诊且接受初始缓解诱导化疗的147例AML（除外急性早幼粒细胞白血病）患者，观察诱导化疗期间接受泊沙康唑抗真菌预防治疗（泊沙康唑组）和未进行广谱抗真菌预防治疗（对照组）IFI的发生率及静脉抗真菌药物使用率。结果147例患者中，81例诱导化疗期间接受泊沙康唑抗真菌预防治疗，为泊沙康唑组；66例未进行广谱抗真菌预防，为对照组。泊沙康唑组中7例发生IFI，发生率为8.6%，均为拟诊病例。对照组患者中19例发生IFI，发生率为28.8%，其中确诊3例，临床诊断4例，拟诊12例。泊沙康唑组IFI发生率显著低于对照组（χ2=10.138，P=0.001）。泊沙康唑组静脉抗真菌药物使用率为18.5%（15/81），显著低于对照组的50.0%（33/66）（χ2=16.390，P〈0.001）。结论应用泊沙康唑在AML诱导化疗期间进行IFI初级预防，能够显著降低IFI发生率及静脉抗真菌药物使用率。

ObjectiveTo evaluate the incidence of invasive fungal infections （IFI） and usage of intravenous antifungal drugs during remission induction chemotherapy in patients with acute myeloid leukemia （AML） under primary antifungal prophylaxis with posaconazole.MethodsClinical records from newly diagnosed AML patients above 15 years old in one single center from February 2014 to January 2016 were retrospectively reviewed and analyzed, excluding acute promyelocytic leukemia. The incidence of IFI and usage of intravenous antifungal drugs were investigated between control group （not receiving any broad spectrum antifungal prophylaxis） and treatment group （receiving posaconazole as primary prophylaxis）.ResultsA total of 147 newly diagnosed AML patients were enrolled. Of them, 81 received prophylaxis with posaconazole, and 66 did not receive broad-spectrum antifungal treatment. 7 IFI occurred in posaconazole group, and all were possible cases; 19 IFI occurred in control group （3 proven, 4 probable, 12 possible）. The incidence of IFI was significantly lower in treatment group than that in control group （8.6% vs 28.8%, χ2=10.138, P=0.001）. Usage of intravenous antifungal drugs was significantly decreased in posaconazole group （18.5% vs 50.0%, χ2=16.390, P〈0.001）.ConclusionProphylaxis with posaconazole coulf prevent IFI and reduce usage of intravenous antifungal drugs significantly during remission induction chemotherapy in AML patients.