伊曲康唑与两性霉素B对急性淋巴细胞白血病患儿化疗并发肺部真菌感染疗效的比较

Efficacy comparison between itraconazole and amphotericin B in children with acute lymphoblastic leukemia complicated with pulmonary fungal infection during chemotherapy

目的比较伊曲康唑与两性霉素B治疗急性淋巴细胞白血病患儿化疗并发肺部真菌感染的疗效。方法回顾性分析中国人民武装警察部队山东省总队医院84例急性淋巴细胞白血病化疗并发肺部真菌感染患儿的临床资料,根据治疗方案分为两性霉素B治疗组(A组)和伊曲康唑治疗组(B组)各42例,比较2组患儿的治疗效果、炎症标志物、不良反应发生率等指标。结果 A组总有效率(95.24%)高于B组(73.81%),发热持续时间短于B组,差异均有统计学意义(P<0.05)。治疗后,2组中性粒细胞计数(NEUT)均高于治疗前、降钙素原(PCT)和C反应蛋白(CRP)均低于治疗前,且A组CRP低于B组,差异均有统计学意义(P<0.05);2组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-4(IL-4)均低于治疗前,且A组低于B组,差异均有统计学意义(P<0.05)。A组不良反应发生率(33.33%)与B组(28.57%)比较,差异无统计学意义(P>0.05)。结论两性霉素B与伊曲康唑治疗白血病化疗并发肺部真菌感染患儿的安全性相近,但前者可显著缩短退热时间、减轻炎症反应,且抗感染疗效更佳。

Objective To compare the efficacy of itraconazole and amphotericin B in treating children with acute lymphoblastic leukemia complicated with pulmonary fungal infection during chemotherapy.Methods The clinical data of 84 children with acute lymphoblastic leukemia complicated with pulmonary fungal infection after chemotherapy admitted into the Chinese People’s Armed Police Force Shangdong Corps Hospital were retrospectively analyzed.According to the treatment scheme,they were divided into amphotericin B treatment group(group A)and itraconazole treatment group(group B),with 42 cases in each group.The therapeutic effect,inflammatory markers,and incidence of adverse reactions of the two groups were compared.Results The total effective rate of the group A(95.24%)was higher than that of the group B(73.81%),and the duration of fever was shorter than that of the group B,the differences were statistically significant(P<0.05).After treatment,the neutrophil counts(NEUT)in both groups were higher than those before treatment,and the procalcitonin(PCT)and C-reactive protein(CRP)were lower than those before treatment,and the CRP in the group A was lower than that in the group B,the differences were statistically significant(P<0.05).The levels of serum tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),and interleukin-4(IL-4)of the two groups were lower than those before treatment,and those in the group A were lower than those in the group B,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the group A(33.33%)and the group B(28.57%)(P>0.05).Conclusion Regarding safety,amphotericin B and itraconazole are similar in the treatment of children with leukemia complicated with pulmonary fungal infection during chemotherapy,but the former can significantly shorten the antipyretic time,alleviate the inflammatory response,and have better anti-infection effect.