伊布替尼致侵袭性真菌感染的文献分析

Literature Analysis of Invasive Fungal Infections Induced by Ibrutinib

目的:探究伊布替尼致侵袭性真菌感染(IFIs)的临床特点,为临床安全使用伊布替尼提供参考。方法:检索国内外数据库,获取伊布替尼所致IFIs的文献,对文献报道病例中的患者年龄、性别、原患疾病,伊布替尼用药剂量、给药途径及合并用药,IFIs发病时间、发生部位、病原学情况、转归及关联性评价等进行统计分析。结果:共纳入48篇文献,73例伊布替尼所致IFIs病例。男性患者数量明显多于女性,60岁以上患者占比最多(82.19%);原患疾病主要为慢性淋巴细胞白血病(64.38%);73例患者中有68例伊布替尼给药剂量符合说明书规定;13例患者联用了其他药物;79.45%的患者IFIs发病时间在用药后6个月内,发生部位主要为肺部(46.94%)及中枢神经系统(30.61%);曲霉菌(49.35%)为主要的致病菌,病死率高达31.51%;大部分病例的药品不良反应关联性评价结果为"很可能"和"可能"。结论:伊布替尼致IFIs具有发病迅速、病死率高的临床特点,应在用药早期加强监控,及时诊断与治疗,确保用药安全。

Objective:To explore the characteristics of invasive fungal infections(IFIs)induced by ibrutinib,and provide reference for clinical safe and rational use of ibrutinib.Methods:Domestic and foreign literature databases were searched and case reports of IFIs caused by ibrutinib were screened.Information such as age,gender,primary disease,dosage and route of ibrutinib,combination drugs,occurrence time of IFIs,location of IFIs,etiology,outcome and relevance evaluation were statistically analyzed.Results:A total of 48 papers,73 cases were extracted.The number of male patients was higher than that of female patients.Patients aged over 60 years old occurred the highest percentage(82.19%),and the primary disease was chronic lymphocytic leukemia(64.38%).The dosage of ibrutinib in 68 of 73 patients was in accordance with the instructions,13 patients had concomitant medication.IFIs of ibrutinib frequently occurred within 6 months after medication(79.45%).The main infection sites were the lungs(46.94%)and the central nervous system(30.61%),and aspergillus(49.35%)was the main pathogen.IFIs had a case fatality rate of 31.51%.The results of relevance evaluation were concentrated in very likely and possible.Conclusion:IFIs induced by ibrutinib were characterized by early-onset and higher case fatality rate.Clinicians and pharmacists should strengthen monitoring at the early stage of drug use,timely diagnosis and treatment in order to ensure the safe use of ibrutinib.