伊曲康唑与卡泊芬净联用对肺部真菌感染病儿肺功能影响及临床疗效

Effect and clinical efficacy of combined use of itraconazole and carpofen on pulmonary function in children with pulmonary fungal infection

目的探讨伊曲康唑与卡泊芬净联用对肺部真菌感染病儿肺功能影响及临床疗效。方法选取2015年2月至2018年10月郑州大学附属儿童医院收治的真菌性肺炎病儿69例,按随机数字表法分为三组,各23例。伊曲康唑组病儿采用伊曲康唑治疗,5 mg/kg,加入100 mL生理盐水中避光静脉滴注;卡泊芬净组病儿采用卡泊芬净治疗,50 mg/m2,加入100 mL生理盐水中静脉滴注;联合用药组病儿采用伊曲康唑联合卡泊芬净治疗,用法、用量与前两组相一致。均每日1次,连续治疗7 d。分析三组病儿治疗后临床疗效。结果69例病儿治疗前病原学检查显示,白色假丝酵母菌占75.4%稳居第一,其次是光滑假丝酵母菌13.0%,曲霉菌7.2%,其他4.3%。联合用药组病儿总有效率为91.3%,伊曲康唑组为73.9%,卡泊芬净组为78.3%,三组总有效率比较差异无统计学意义(P>0.05)。治疗前,三组病儿中性粒细胞计数、白细胞计数、降钙素原及γ干扰素水平及肺功能指标比较差异无统计学意义(P>0.05)。治疗后,联合用药组病儿中性粒细胞计数、白细胞计数、降钙素原水平低于伊曲康唑组和卡泊芬净组,γ干扰素、一秒量(FEV1)、最高呼气流速(PEF)、用力呼气量(FVC)水平高于伊曲康唑组和卡泊芬净组(P<0.05)。结论伊曲康唑联合卡泊芬净治疗真菌性肺炎可改善病儿肺功能,疗效显著。

Objective To explore the effect and clinical efficacy of combined use of itraconazole and caspofungin on lung function in children with pulmonary fungal infection.Methods 69 children with fungal pneumonia admitted to the Children's Hospital of Zheng⁃zhou University from February 2015 to October 2018 were divided into three groups according to a random number table,with 23 cases in each group.Children in the itraconazole group were treated with itraconazole,5 mg/kg,added to 100 mL of normal saline by intrave⁃nous drip in the dark;children in the caspofungin group were treated with caspofungin,50 mg/m2,100 mL of normal saline was added intravenously;children in the combination group were treated with itraconazole and caspofungin,and the usage and dosage were the same as those of the previous two groups.All were treated once a day for 7 consecutive days.The clinical efficacy of the three groups of children after treatment was analyzed.Results The pathogenic examination of 69 children before treatment showed that Candida albi⁃cans accounted for 75.4%,ranking first,followed by Candida glabrata 13.0%,Aspergillus 7.2%,and others 4.3%.The total effective rate was 91.3%in the combined medication group,73.9%in the itraconazole group,and 78.3%in the caspofungin group.There was no significant difference in the total effective rate among the three groups(P>0.05).Before treatment,there was no significant difference in neutrophil count,white blood cell count,procalcitonin and interferon gamma levels and lung function indexes among the three groups of children(P>0.05).After treatment,the neutrophil count,white blood cell count,and procalcitonin levels of children in the combination group were lower than those in the itraconazole group and caspofungin group,interferon gamma,forced expiratory volume per second,(FEV1),maximum expiratory flow rate(PEF),and forced expiratory volume(FVC)levels were higher than those in the itraconazole group and caspofungin group(P<0.05).Conclusion Itraconazole combined with caspofungin in the treatment of fungal pneumonia can improve the lung function of children with significant effects.