CAJ | 학술논문

目的评价伊曲康唑联合重组人粒细胞集落刺激因子（rhG-CSF）治疗中性粒细胞减少的血液病患者合并侵袭性真菌感染的临床疗效及安全性。方法回顾性分析2007年1月至2011年12月收治的103例血液病合并真菌感染的患者，治疗期间72例患者出现粒细胞缺乏，其中44例患者应用伊曲康唑联合rhG-CSF治疗（治疗组），28例患者单独应用伊曲康唑治疗（对照组）。结果治疗组患者有效率为72.73％，对照组为46.43％（ P＜0.05）；中性粒细胞≤500/mm3且≥100/mm3的患者抗真菌治疗有效率明显高于中性粒细胞≤100/mm3的患者（ P＜0.05）；粒缺持续时间≤10 d的抗真菌治疗有效率明显低于粒缺持续时间＜10 d的患者（ P＜0.05）；72例患者中确诊9例、临床诊断33例、拟诊30例；确诊组有效率低于临床诊断与拟诊组（ P＜0.05），抢先性治疗组（87.50％）和经验性治疗组（64.00％）的有效率均明显高于目标性治疗组（34.78％），差异有统计学意义（P均＜0.05）。结论伊曲康唑联合rhG-CSF治疗中性粒细胞减少的血液病患者真菌感染是有效安全的；中性粒细胞减少的程度和时间是影响真菌治疗效果的重要因素。
목적평개이곡강서연합중조인립세포집락자격인자（rhG-CSF）치료중성립세포감소적혈액병환자합병침습성진균감염적림상료효급안전성。방법회고성분석2007년1월지2011년12월수치적103례혈액병합병진균감염적환자，치료기간72례환자출현립세포결핍，기중44례환자응용이곡강서연합rhG-CSF치료（치료조），28례환자단독응용이곡강서치료（대조조）。결과치료조환자유효솔위72.73％，대조조위46.43％（ P＜0.05）；중성립세포≤500/mm3차≥100/mm3적환자항진균치료유효솔명현고우중성립세포≤100/mm3적환자（ P＜0.05）；립결지속시간≤10 d적항진균치료유효솔명현저우립결지속시간＜10 d적환자（ P＜0.05）；72례환자중학진9례、림상진단33례、의진30례；학진조유효솔저우림상진단여의진조（ P＜0.05），창선성치료조（87.50％）화경험성치료조（64.00％）적유효솔균명현고우목표성치료조（34.78％），차이유통계학의의（P균＜0.05）。결론이곡강서연합rhG-CSF치료중성립세포감소적혈액병환자진균감염시유효안전적；중성립세포감소적정도화시간시영향진균치료효과적중요인소。
Objective To evaluate the clinical efficacy and safety of itraconazole combined with recombinant human granulocyte colony-stimulating factor ( rhG-CSF ) in treatment of neutropenic patients with hematological diseases who were suffering from invasive fungal infections ( IFI) .Methods 103 IFI patients from Jan 2007 to Dec 2011 were retrospectively analysed and 72 patients generated agranulocytosis .44 patients were treated with itraconazole combined with rhG-CSF ( treatment group ) and 28 patients were treated with itraconazole alone ( control group ) during treatment .Results The response rate was 72.70% in treat group and 46.40% in control group.The effect of antifungal therapy decreased when the absolute neutrophil count declined to less than 100 cells/mm3 and increased further when the count declined to less than 500 cells/mm3 and more than 100 cells/mm3 . Patients who remained neutropenic for more than 10 days were less effective than those who remained neutropenic for less than 10 days.There were 9 proven,33 probable and 30 possible patients.The effective rate of patients with proven IFI was significantly lower than patients with probable IFI and possible IFI ( P<0.05) .The effective rate of preemptive and empirical therapy groups was equally higher than that of goal therapy group ( P<0.05) .Conclusions Itraconazole combined with rhG-CSF is safe and effective in the treatment of IFI neutropenic patients with hematological diseases . The severity and duration of neutropenia is considered a major fator for the effect of antifungal therapy .