血液肿瘤患者侵袭性真菌病经验治疗与诊断驱动治疗的对比研究

Empirical versus diagnostic-driven antifungal therapy for hematological malignancies patients with invasive fungal disease

目的对比分析血液肿瘤患者侵袭性真菌病(IFD)经验治疗与诊断驱动治疗的临床价值.方法回顾性分析2017年8月-2018年8月在中国医学科学院北京协和医学院肿瘤医院深圳医院血液淋巴瘤科接受抗真菌治疗的血液肿瘤患者的临床资料.共有68例患者符合纳入标准,其中经验治疗组28例,诊断驱动治疗组40例,比较两组间IFD发病率、IFD相关死亡率、住院天数、抗真菌治疗天数差异.结果诊断驱动治疗组IFD发病率高于经验治疗组,分别为27.5%(11/40)和7.1%(2/28),差异有统计学意义(χ^2=4.414,P=0.036).两组IFD相关死亡率分别为7.5%(3/40)和3.6%(1/28),差异无统计学意义(χ^2=0.459,P=0.498).诊断驱动治疗组抗真菌治疗天数长于经验治疗组[(15.9±3.3)d:(13.1±2.5)d,t=-3.654,P=0.001],而住院天数两组差异无统计学意义[(20.1±2.1)d:(19.4±2.3)d,t=-1.273,P=0.208].结论诊断驱动治疗和经验治疗均有助于早期抗真菌治疗,需根据实际情况作恰当选择.

Objective To compare the clinical efficacy of empirical therapy and diagnostic-driven the-rapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). Methods The clinical data of patients with hematological malignancies undergoing antifungal treatment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital, Chinese Aca-demy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria, of which, 28 received the empirical therapy and 40 received the diagnostic-driven therapy. Then the differences of the incidence of IFD, IFD-related mortality, days of hospitalization and antifungal treatment between the two groups were compared. Results The incidence of IFD in the diagnostic-driven therapy group was higher than that in the empirical therapy group [27.5%(11/40) vs. 7.1%(2/28),χ^2=4.414, P=0.036]. While the rates of IFD-related mortality were 7.5%(3/40) and 3.6%(1/28) respectively, with no statistically significant difference (χ^2=0.459, P=0.498). The number of antifungal treatment days in the diagnostic-driven therapy group was greater than that in the empirical therapy group [(15.9±3.3) d vs.(13.1±2.5) d, t=-3.654, P=0.001]. While the numbers of hospitalization days were similar in the two groups [(20.1±2.1) d vs.(19.4±2.3) d], with no statistically significant difference (t=-1.273, P=0.208). Conclusion Both diagnostic-driven therapy and empirical therapy are helpful to early antifungal treatment, and they should be performed properly combined with the actual clinical conditions.