CAJ | 학술논문

目的探讨不同时机两性霉素B脂质体治疗慢性阻塞性肺疾病（ COPD ）合并侵袭性肺部真菌感染（ IPFI）的疗效及安全性。方法本文回顾性分析我科2010年8月至2012年2月，COPD合并IPFI的28例患者应用两性霉素B脂质体的临床资料，其诊断标准参见中华医学会呼吸分会制定的《慢性阻塞性肺病诊治规范2007修订版》和《侵袭性肺部真菌感染的诊断标准与治疗原则（草案）》，观察并探讨了不同时机两性霉素B脂质体治疗COPD合并IPFI有效性及治疗时机选择等，治疗期间监测肺影像学、肝肾功能电解质、体温等变化，以观察两性霉素B脂质体不良反应。结果临床诊断、拟诊各22、6例；抢先/经验治疗组有效率为76.47％，高于挽救/目标治疗组的45.45％，差异有统计学意义（ P＜0.05）；疗程比较方面：挽救治疗组疗程为（22.32±5.45）d，长于抢先治疗组的（13.40±4.34）d，差异有统计学意义（P＜0.05）；不良反应发生率比较：挽救治疗组不良反应率（57.14％）高于抢先治疗组不良反应率（39.29％），且差异具有统计学意义（ P＜0.05）。结论两性霉素B脂质体是治疗COPD合并IPFI安全有效的药物，抢先治疗能提高疗效，且能减少不良反应发生率，临床工作中值得进一步研究证实。
목적탐토불동시궤량성매소B지질체치료만성조새성폐질병（ COPD ）합병침습성폐부진균감염（ IPFI）적료효급안전성。방법본문회고성분석아과2010년8월지2012년2월，COPD합병IPFI적28례환자응용량성매소B지질체적림상자료，기진단표준삼견중화의학회호흡분회제정적《만성조새성폐병진치규범2007수정판》화《침습성폐부진균감염적진단표준여치료원칙（초안）》，관찰병탐토료불동시궤량성매소B지질체치료COPD합병IPFI유효성급치료시궤선택등，치료기간감측폐영상학、간신공능전해질、체온등변화，이관찰량성매소B지질체불량반응。결과림상진단、의진각22、6례；창선/경험치료조유효솔위76.47％，고우만구/목표치료조적45.45％，차이유통계학의의（ P＜0.05）；료정비교방면：만구치료조료정위（22.32±5.45）d，장우창선치료조적（13.40±4.34）d，차이유통계학의의（P＜0.05）；불량반응발생솔비교：만구치료조불량반응솔（57.14％）고우창선치료조불량반응솔（39.29％），차차이구유통계학의의（ P＜0.05）。결론량성매소B지질체시치료COPD합병IPFI안전유효적약물，창선치료능제고료효，차능감소불량반응발생솔，림상공작중치득진일보연구증실。
Objective To investigate the efficacy and safety of the different timing of amphotericin B liposome treatment of COPD with invasive pulmonary fungal infections patients .Methods The clinical data of 28 cases COPD patients with IPFI treated by amphotericin B liposome between Aug 2010 and Feb 2012 were retrospectively analyzed .The study was designed to investigate efficacy and safety of the different timing of amphotericin B liposome treatment of COPD with invasive pulmonary fungal infections patients .Lunges image,liver and kidney function were monitored during the period of treatment .Results There were 22 probable cases COPD patients with IPFI,and 6 possible cases.The over all effective rate of preemptive/empirical therapy group(76.47%) was higher than that in goal/rescue therapy group (45.45%) .The average duration of the amphotericin B liposome in therapy of the effective group was longer than that of ineffective group [(22.32 ±5.45)d vs.(13.40 ±4.34)d,P<0.05 ] .Drug-related side effects between the two groups were found that preemptive /empirical therapy group was lower than that of goal/rescue therapy group during treatment .Conclusions Amphotericin B liposome is an effective and safe antifungal drug for COPD patients with IPFI .Preemptive therapy may improve the curative effect .