血液病合并侵袭性真菌病患者进行伏立康唑诊断驱动治疗的价值

Value of the Diagnostic-Driven Therapy with Voriconazole in Patients with Hematological Disorders Complicated by Invasive Fungal Disease

目的:探讨伏立康唑在血液病合并侵袭性真菌病(IFD)患者中诊断驱动治疗的价值。方法:回顾性分析2019年7月至2020年7月在中国人民解放军南部战区总医院血液科住院接受伏立康唑治疗的111例血液病患者的相关资料,比较经验治疗和诊断驱动治疗对伏立康唑使用时间、平均住院日和抗真菌疗效的差异。运用SPSS 23.0进行数据统计分析。结果:相对于诊断驱动治疗,经验性治疗组有更多的IFD高危患者,粒细胞缺乏患者比例更高(95.2%vs 69.5%,P=0.003),但两组患者的伏立康唑使用时间、住院时间、疗效差异无统计学意义。结论:在相对低危的患者中使用诊断驱动治疗,可获得与高危患者经验性治疗相似的治疗结局和预后,两种策略需根据患者的具体情况做出合适的选择。

Objective:To explore the value of the diagnostic-driven therapy with voriconazole in patients with hematological disorders complicated by invasive fungal disease(IFD).Methods:A total of 111 patients with hematological disorders complicated by IFD,treated with voriconazole in the hematology department of the General Hospital of South Theatre Command from July 2019 to July 2020,were retrospectively analyzed to compare the differences between the empirical therapy and the diagnostic-driven therapy on the treatment time of voriconazole,hospitalization days and antifungal efficacy.SPSS 23.0 was used for statistical analysis of data.Results:Compared with the diagnostic-driven therapy group,the empirical therapy group had more IFD high-risk patients,including a higher proportion of agranulocytosis patients(95.2%vs 69.5%,P=0.003).However,there were no significant differences on the treatment time of voriconazole,hospitalization days and antifungal efficacy of voriconazole between the two groups.Conclusion:Using diagnostic-driven therapy in relatively IFD low-risk patients can obtain similar therapeutic outcomes and prognosis as empirical therapy in high-risk patients.Either of two strategies can be used in clinical practice according to the individual conditions of patients.