伏立康唑联合不同剂量泼尼松治疗变应性支气管肺曲霉病疗效观察

Effect of voriconazole combined with different doses of prednisone in the treatment of allergic bronchopulmonary aspergillosis

目的探讨伏立康唑联合不同剂量泼尼松治疗变应性支气管肺曲霉病(ABPA)的临床效果,为ABPA的临床治疗提供参考。方法选择2016年2月至2018年2月首都医科大学大兴教学医院收治的84例ABPA患者为研究对象,根据治疗方法将患者分为A组和B组,每组42例。2组患者均给予吸氧、抗感染、止咳平喘、化痰、支气管扩张等常规治疗,在常规治疗基础上,A组患者给予伏立康唑联合小剂量泼尼松(0.25 mg·kg^-1·d^-1)治疗,B组患者给予伏立康唑联合中等剂量泼尼松(0.5 mg·kg^-1·d^-1)治疗,2组患者均连续治疗4个月。分别于治疗前后检测患者嗜酸性粒细胞及血清总免疫球蛋白E(IgE)和烟曲霉特异性IgE水平,使用肺功能仪检测患者肺功能,记录第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FVC)的比值(FEV1/FVC)、最大呼气流量(PEF);治疗后评估2组患者临床疗效,并观察2组患者治疗过程中不良反应发生情况。结果2组患者治疗前嗜酸性粒细胞及血清总IgE、烟曲霉特异性IgE水平比较差异无统计学意义(P>0.05),2组患者治疗后嗜酸性粒细胞及血清总Ig E、烟曲霉特异性IgE水平显著低于治疗前(P<0.05),2组患者治疗后嗜酸性粒细胞及血清总IgE、烟曲霉特异性IgE水平比较差异无统计学意义(P>0.05)。2组患者治疗前FEV1、FEV1/FVC、PEF比较差异无统计学意义(P>0.05),2组患者治疗后FEV1、FEV1/FVC、PEF显著高于治疗前(P<0.05),2组患者治疗后FEV1、FEV1/FVC、PEF比较差异无统计学意义(P>0.05)。A组和B组患者治疗总有效率分别为97.62%(41/42)、90.48%(38/42),2组患者治疗总有效率比较差异无统计学意义(χ^2=1.914,P>0.05)。A组和B组患者不良反应发生率分别为2.38%(1/42)、14.29%(6/42),A组患者不良反应发生率低于B组(χ^2=3.896,P<0.05)。结论伏立康唑联合小剂量、中等剂量泼尼松治疗ABPA的疗效相当,但小剂量泼尼松的不良反应少。

Objective To investigate the clinical effect of voriconazole combined with different doses of prednisone in the treatment of allergic bronchopulmonary aspergillosis(ABPA),so as to provide a reference for clinical treatment of ABPA.Methods A total of 84 patients with ABPA admitted to Daxing Teaching Hospital of Capital Medical University from February 2016 to February 2018 were selected as the study objects,they were divided into group A and group B according to the treatment methods,with 42 cases in each group.The patients in both groups were given routine treatment such as oxygen inhalation,anti-infection,relieving cough and asthma,dissipate phlegm and dilating bronchus.On the basis of routine treatment,the patients in group A were treated with voriconazole combined with low-dose prednisone(0.25 mg·kg^-1·d^-1),and the patients in group B were treated with voriconazole combined with medium-dose prednisone(0.5 mg·kg^-1·d^-1).All the patients in both groups were treated for 4 months.Before and after treatment,the levels of eosinophils,serum total immunoglobulin E(IgE)and Aspergillus fumigatus specific IgE were detected;the pulmonary function of the patients was measured by pulmonary function instrument,including forced expiratory volume(FEV1),the ratio of FEV1 to forced vital capacity(FVC)and peak expiratory flow(PEF).The clinical effect of the patients in the two groups was evaluated after treatment,and the adverse reactions were observed.Results There was no significant difference in the levels of eosinophils,serum total IgE and Aspergillus fumigatus specific IgE between the two groups before treatment(P>0.05).The levels of eosinophils and serum total IgE and Aspergillus fumigatus specific IgE after treatment were significantly lower than those before treatment in the two groups(P<0.05).There was no significant difference in the levels of eosinophils,serum total IgE and Aspergillus fumigatus specific IgE between the two groups after treatment(P>0.05).There was no significant difference in FEV1,FEV1/FVC and PEF between the two groups before treatment(P>0.05).The FEV1,FEV1/FVC and PEF after treatment were significantly higher than those before treatment in the two groups(P<0.05).There was no significant difference in FEV1,FEV1/FVC and PEF between the two groups after treatment(P>0.05).The total effective rate in group A and group B was 97.62%(41/42)and 90.48%(38/42),respectively.There was no significant difference in the total effective rate between the two groups(χ^2=1.914,P>0.05).The incidence of adverse reactions in group A and group B was 2.38%(1/42)and 14.29%(6/42),respectively.The incidence of adverse reactions in group A was lower than that in group B(χ^2=3.896,P<0.05).Conclusion The efficacy of voriconazole combined with low-dose and medium-dose prednisone in the treatment of ABPA is similar,but the adverse reactions of low-dose prednisone are less.