卡泊芬净在异基因造血干细胞移植中真菌二级预防的应用

Application of caspofungin in secondary prevention of fungus in patients undergoing allogeneic hematopoietic stem cell transplantation

目的探讨卡泊芬净在异基因造血干细胞移植(allo-HSCT)中对真菌二级预防的安全性与有效性。方法选择2013年1月—2017年4月河北燕达陆道培医院收治的40例资料完整,且诊断为真菌感染的allo-HSCT术后患者,参照2010版《血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则》(修订版)标准对患者进行分层诊断,采用卡泊芬净进行治疗。对患者分层诊断情况进行分析,评价患者采用卡泊芬净治疗的临床疗效及相关不良反应。结果 40例患者经分层诊断并采用卡泊芬净进行治疗后,4例确诊患者有效率为100.00%,22例临床诊断患者有效率为77.27%,14例拟诊断患者有效率为71.43%,临床诊断患者有效率与拟诊断患者比较,差异无统计学意义(P>0.05)。治疗过程中患者发生的不良反应主要以低血钾症(9例)、低血糖症(7例)为主,给予对症治疗后症状均得到缓解。结论卡泊芬净应用于异基因造血干细胞移植中,治疗效果较好,不良反应较少,安全性高,值得在真菌感染二级预防中推广使用。

Objective To investigate the safety and efficacy of Caspofungin in secondary prevention of fungi in patients with allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods The clinical data of 40 cases of allo-HSCT with fungal infection stratified according to the 2010 edition of Diagnostic Standards and Therapeutic Principles for Invasive Fungal Infection in Patients with Hematological Diseases/Malignant Tumors(Revised edition) in our hospital from January 2013 to April 2017 were reviewed. All patients were administrated with Caspofungin. The stratified diagnosis of patients was analyzed, and the clinical efficacy and adverse reactions of Caspofungin were evaluated. Results After stratified diagnosis and treatment with Caspofungin, the effective rate in the 4 confirmed patients was 100.00%, in 22 clinically diagnosed patients was 77.27%, and in 14 prospectively diagnosed patients was 71.43%. There was no significant difference in the effective rate between clinically diagnosed patients and prospectively diagnosed patients(P>0.05). In the course of treatment, the main adverse reactions were hypokalemia(9 cases) and hypoglycemia(7 cases). After symptomatic treatment, the symptoms were alleviated. Conclusion Caspofungin has good therapeutic effect, with fewer adverse reactions and high safety in allogeneic hematopoietic stem cell transplantation. It is worth popularizing in secondary prevention of bacterial infection.