两种抗菌药物对儿童ALL化疗期继发侵袭性真菌感染疗效及安全性的影响

Effects of Two Antibacterial on the Efficacy and Safety in Children with Secondary Invasive Fungal Infection during ALL Chemotherapy

目的:探讨两性霉素B和伏立康唑对儿童急性淋巴细胞白血病(ALL)化疗期继发侵袭性真菌感染疗效及安全性的影响。方法:选取笔者所在医院2015年1月-2018年5月收治的儿童ALL化疗期继发侵袭性真菌感染患儿87例,根据治疗方案不同分组,其中采用两性霉素B共47例设为两性霉素B组,采用伏立康唑40例设为伏立康唑组,比较两组治疗总有效率、健康调查问卷(SF-36)评分及不良反应发生率。结果:伏立康唑组治疗总有效率高于两性霉素B组,差异有统计学意义(P<0.05);伏立康唑组躯体健康评分、精力评分及情绪控制评分均高于两性霉素B组,差异均有统计学意义(P<0.05);两组疼痛和精神健康评分比较差异无统计学意义(P>0.05);伏立康唑组肾功能损伤、消化功能障碍及神经毒性发生率均低于两性霉素B组,差异均有统计学意义(P<0.05);两组肝功能损伤和视觉障碍发生率比较无统计学意义(P>0.05)。结论:相较于两性霉素B,伏立康唑治疗儿童ALL化疗期继发侵袭性真菌感染能够有效提高病情控制效果,改善生存质量,且安全性更佳。

Objective:To investigate the effects of Amphotericin B and Voriconazole on the efficacy and safety of pediatric acute lymphoblastic leukemia(ALL)with secondary invasive fungal infection during chemotherapy.Method:A total of 87 children with secondary invasive fungal infection during ALL chemotherapy in our hospital from January 2015 to May 2018 were selected,according to different treatment regiments,47 patients receiving Amphotericin B were assigned to the Amphotericin B group,and 40 patients receiving Voriconazole were assigned to the Voriconazole group,the total effective rate,health questionnaire(SF-36)score and the incidence of adverse reactions were compared between the two groups.Result:The total effective rate in the Voriconazole group was higher than that in the Amphotericin B group,the difference was statistically significant(P<0.05).The scores of physical health,energy and emotional control in the Voriconazole group were higher than those in the Amphotericin B group,the differences were statistically significant(P<0.05).There were no significant differences in pain and mental health scores between the two groups(P>0.05),the physical health score,energy score and emotion control score in the Voriconazole group were higher than those in the Amphotericin B group after treatment,the differences were statistically significant(P<0.05).The incidence of renal impairment,digestive dysfunction and neurotoxicity in the Voriconazole group was lower than that in the Amphotericin B group,the differences were statistically significant(P<0.05),there was no statistical significance in the incidence of liver function injury and visual impairment between the two groups(P>0.05).Conclusion:Compares with Amphotericin B,Voriconazole in treatment of ALL children with invasive fungal infections secondary in chemotherapy period can efficiently improve the clinical effect of disease control,improve the quality of life and possess better safety.