氟康唑和伏立康唑治疗重症肝病并发肺部真菌感染的临床效果及影像学分析

Clinical effect of fluconazole and voriconazole on treatment of severe liver disease complicated with pulmonary fungal infection and imaging characteristics

目的采用多层螺旋CT(MSCT)评价氟康唑和伏立康唑治疗重症肝病并发肺部真菌感染的临床效果。方法选取2010年1月-2017年6月医院收治的158例重症肝病合并肺部真菌感染的患者作为研究对象。根据应用抗菌药物不同分为氟康唑组和伏立康唑组,每组79例。统计两组患者真菌感染类型,以半乳甘露聚糖(glactomannan,GM)及病原学检查的结果为重症肝病肺部真菌感染诊断的金标准,分析MSCT诊断肺部真菌感染的准确度、灵敏度、特异性、阳性预测值及阴性预测值;观察两组患者的临床疗效,比较治疗后两组患者MSCT影像学特点,统计两组患者治疗不良反应。结果氟康唑组和伏立康唑组患者检出真菌主要为酵母样真菌,分别占75.25%和79.61%,两组比较差异无统计学意义;MSCT诊断的准确度、灵敏度、特异性、阳性预测值及阴性预测值分别为92.21%、93.41%、85.07%、89.47%和90.48%;治疗结束后伏立康唑组患者的发热消退、真菌消除人数分别为74例(93.67%)和69例(87.34%),高于氟康唑组(P<0.05);治疗后,两组患者肺部出现渗出、结节及空洞的情况均减少(P<0.05),伏立康唑组患者结节和空洞减少比例高于氟康唑组(P<0.05);治疗期间,患者会出现轻度的转氨酶升高、低钾症、恶心呕吐、腹泻等药物不良反应。结论 MSCT在重症肝病并发肺部真菌感染的诊断及药效评价中具有重要作用,氟康唑和伏立康唑的使用,均能够起到较好的抗真菌作用,安全性较高,且伏立康唑的临床效果更佳。

OBJECTIVE To evaluate the clinical effect of fluconazole and voriconazole on treatment of severe liver disease complicated with pulmonary fungal infection by using multi-slice spiral CT(MSCT). METHODS A total of 158 severe liver disease patients complicated with pulmonary fungal infection who were treated in hospitals from Jan 2010 to Jun 2017 were recruited as the study objects and divided into the fluconazole group and the voriconazole group according to the antibiotics used for treatment, with 79 cases in each group.The types of fungal infection were statistically analyzed, the galactomannan(GM) and result of etiological examination were the gold standards for diagnosis of severe liver disease complicated with pulmonary fungal infection, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MSCT in diagnosis of pulmonary fungal infection were analyzed, the clinical curative effects were observed, the imaging characteristics of MSCT were compared between the two groups of patients after the treatment, and the adverse reactions in the two groups of patients were statistically analyzed. RESULTS The yeast-like fungi were dominant among the pathogenic fungi isolated from the patients in the fluconazole group and the voriconazole group, accounting for 75.25% and 79.61%, respectively.The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MSCT were respectively 92.21%, 93.41%, 85.07%, 89.47% and 90.48% in diagnosis of the pulmonary fungal infection.The proportions of the patients whose fever subsided and fungi eradicated were respectively 93.67%(74 case) and 87.34%(69 cases) in the voriconazole group after the treatment, significantly higher than those in the fluconazole group(P<0.05).The incidence of pulmonary exudation, nodules and voids of the two groups of patients were significantly decreased after the treatment(P<0.05);the proportions of the patients who had nodules and voids were significantly higher in the voriconazole group than in the fluconazole group(P<0.05).The patients may have the drug-induced adverse reactions such as slight rise of transaminase, low-potassium, nausea and vomiting as well as diarrhea. CONCLUSION MSCT plays an important role in diagnosis of pulmonary fungal infection in patients with severe liver disease and evaluation of effect of drugs.Both fluconazole and voriconazole have remarkable antifungal effect, with the safety high, and the clinical effect of voriconazole is better.