卡泊芬净对重症侵袭性假丝酵母菌感染降阶梯治疗的效果评价

Evaluation of caspofungin in de-escalation therapy for severely invasive Candida infection

目的探讨卡泊芬净在重症侵袭性假丝酵母菌感染降阶梯治疗中的效果。方法选取70例重症侵袭性假丝酵母菌感染患者,随机分为观察组与对照组,各35例,对照组给予氟康唑静脉滴注,观察组给予卡泊芬净联合氟康唑降阶梯治疗,比较2组的临床疗效、真菌清除率、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、序贯性器官功能衰竭评分(SOFA)和不良反应发生率。结果观察组与对照组治疗后1周有效率分别为28.57%、14.29%,P>0.05;观察组治疗后2周、治疗后3周有效率分别为45.71%、62.86%,均高于对照组(22.86%、37.14%),P<0.05;观察组与对照组治疗后1周真菌清除率分别为16.67%、11.76%,P>0.05;观察组治疗后1周、2周和3周血清肿瘤坏死因子-α(TNF-α)和白细胞介素-12(IL-12)水平低于对照组,白细胞介素-4(IL-4)和白细胞介素-10(IL-10)水平高于对照组(P<0.05);观察组治疗后2周、治疗后3周真菌清除率分别为61.11%、83.33%,均高于对照组(23.53%、47.06%),P<0.05;2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论卡泊芬净在重症侵袭性假丝酵母菌感染降阶梯治疗中疗效显著,具有较好的安全性与耐受性。

Objective To explore the effects of caspofungin in de-escalation therapy for severe invasive Candida infection.Methods A total of 70 patients with severe invasive Candida infection were enrolled,and randomly divided into observation group and control group,35 cases in each group.The control group were given fluconazole for intravenous drip,while the observation group were given caspofungin combined with fluconazole for de-escalation therapy.The clinical curative effect,fungal clearance rate,scores of acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA),and the incidence of adverse reactions were compared between the 2 groups.Results After 1 week of treatment,the effective rates of the observation group and control group were 28.57%and 14.29%(P>0.05),respectively.After 2 weeks and 3 weeks of treatment,the response rates in observation group were 45.71%and 62.86%,respectively,which were higher than those in control group(22.86%,37.14%)(P<0.05).After 1 week of treatment,the fungal clearance rate of the observation group and control group were 16.67 and 11.76%(P>0.05),respectively.After 1,2,and 3 weeks of treatment,levels of serum tumor necrosis factor-α(TNF-α)and interleukin-12(IL-12)in observation group were lower than those in control group,while levels of interleukin-4(IL-4)and interleukin-10(IL-10)were higher than those in control group(P<0.05).After 2 weeks and 3 weeks of treatment,fungal clearance rates in observation group were 61.11%and 83.33%,respectively,which were higher than those in control group(23.53%,47.06%)(P<0.05).There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05).Conclusion Effects of caspofungin are significant in de-escalation therapy for severe invasive Candida infection with good safety and tolerance.