中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
7期
577-580
,共4页
邱志祥%任汉云%岑溪南%欧晋平%许蔚林%王茫桔%王莉红%董玉君%李渊
邱誌祥%任漢雲%岑溪南%歐晉平%許蔚林%王茫桔%王莉紅%董玉君%李淵
구지상%임한운%잠계남%구진평%허위림%왕망길%왕리홍%동옥군%리연
伏立康唑%造血干细胞移植%侵袭性真菌病%一级预防
伏立康唑%造血榦細胞移植%侵襲性真菌病%一級預防
복립강서%조혈간세포이식%침습성진균병%일급예방
Voriconazole%Hematopoietic stem cell transplantation%Invasive fungal disease%Primary prevention
目的 探讨静脉应用伏立康唑对异基因造血干细胞移植(allo-HSCT)后侵袭性真菌病(IFD)一级预防的疗效及耐受性.方法 移植前无真菌感染的allo-HSCT患者从预处理开始应用伏立康唑注射液,直至患者的中性粒细胞恢复至0.5× 109/L以上,以口服氟康唑者为对照组,分析两组间IFD易感因素有无差异,比较两组IFD发生率及药物不良反应的差异.结果 227例患者在移植后3个月内有33例(14.54％)发生IFD,中位随访38(5～76)个月,发生IFD患者累计死亡13例(33.96％),20例存活,总生存率60.61％;194例未发生IFD患者,累计死亡40例(19.89％),154例(79.38％)存活,两组间总生存率差异有统计学意义(P=0.029).227例患者中,83例应用伏立康唑行一级预防,发生IFD者7例(8.43％),对照组144例患者发生IFD 26例(18.06％),两组IFD发生率差异有统计学意义(P=0.048).对两组间的性别、年龄、既往有无慢性病、移植时是否为进展期血液病、移植方式、预处理方案、粒细胞缺乏时间、有无急性移植物抗宿主病、有无CMV感染等因素逐一进行比较,结果显示两组上述因素差异无统计学意义(P＞0.05).伏立康唑和氟康唑两组间转氨酶升高患者比例差异无统计学意义(P＞0.05).应用伏立康唑出现幻听或视觉障碍等不良反应的比例不高.结论 应用静脉伏立康唑对allo-HSCT患者行IFD的一级预防的效果明显优于氟康唑,且患者对治疗的耐受性良好.
目的 探討靜脈應用伏立康唑對異基因造血榦細胞移植(allo-HSCT)後侵襲性真菌病(IFD)一級預防的療效及耐受性.方法 移植前無真菌感染的allo-HSCT患者從預處理開始應用伏立康唑註射液,直至患者的中性粒細胞恢複至0.5× 109/L以上,以口服氟康唑者為對照組,分析兩組間IFD易感因素有無差異,比較兩組IFD髮生率及藥物不良反應的差異.結果 227例患者在移植後3箇月內有33例(14.54％)髮生IFD,中位隨訪38(5～76)箇月,髮生IFD患者纍計死亡13例(33.96％),20例存活,總生存率60.61％;194例未髮生IFD患者,纍計死亡40例(19.89％),154例(79.38％)存活,兩組間總生存率差異有統計學意義(P=0.029).227例患者中,83例應用伏立康唑行一級預防,髮生IFD者7例(8.43％),對照組144例患者髮生IFD 26例(18.06％),兩組IFD髮生率差異有統計學意義(P=0.048).對兩組間的性彆、年齡、既往有無慢性病、移植時是否為進展期血液病、移植方式、預處理方案、粒細胞缺乏時間、有無急性移植物抗宿主病、有無CMV感染等因素逐一進行比較,結果顯示兩組上述因素差異無統計學意義(P＞0.05).伏立康唑和氟康唑兩組間轉氨酶升高患者比例差異無統計學意義(P＞0.05).應用伏立康唑齣現幻聽或視覺障礙等不良反應的比例不高.結論 應用靜脈伏立康唑對allo-HSCT患者行IFD的一級預防的效果明顯優于氟康唑,且患者對治療的耐受性良好.
목적 탐토정맥응용복립강서대이기인조혈간세포이식(allo-HSCT)후침습성진균병(IFD)일급예방적료효급내수성.방법 이식전무진균감염적allo-HSCT환자종예처리개시응용복립강서주사액,직지환자적중성립세포회복지0.5× 109/L이상,이구복불강서자위대조조,분석량조간IFD역감인소유무차이,비교량조IFD발생솔급약물불량반응적차이.결과 227례환자재이식후3개월내유33례(14.54％)발생IFD,중위수방38(5～76)개월,발생IFD환자루계사망13례(33.96％),20례존활,총생존솔60.61％;194례미발생IFD환자,루계사망40례(19.89％),154례(79.38％)존활,량조간총생존솔차이유통계학의의(P=0.029).227례환자중,83례응용복립강서행일급예방,발생IFD자7례(8.43％),대조조144례환자발생IFD 26례(18.06％),량조IFD발생솔차이유통계학의의(P=0.048).대량조간적성별、년령、기왕유무만성병、이식시시부위진전기혈액병、이식방식、예처리방안、립세포결핍시간、유무급성이식물항숙주병、유무CMV감염등인소축일진행비교,결과현시량조상술인소차이무통계학의의(P＞0.05).복립강서화불강서량조간전안매승고환자비례차이무통계학의의(P＞0.05).응용복립강서출현환은혹시각장애등불량반응적비례불고.결론 응용정맥복립강서대allo-HSCT환자행IFD적일급예방적효과명현우우불강서,차환자대치료적내수성량호.
Objective To investigate the efficacy and tolerability of intravenous vonconazole on primary prevention in invasive fungal disease (IFD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods At the time of conditioning regimen,patients without IFD was intravenously administered with voriconazole at a dose of 100 mg two times per day until neutrophils greater than 0.5 × 109/L.Patients treated with oral fluconazole,200 mg per day,were control group.The incidence and risk factors of IFD and side effects of medicines were evaluated.Results Of the total 227 patients,33 (14.54％) had IFD within 3 months after allo-HSCT.There was significant difference on overall survival between patients with or without IFD by Kaplan-Meier survival curve (P=0.029).Of the 83 cases with intravenous voriconazole,7 cases occurred IFD (8.43％).In contrast,the incidence of IFD in control group was 18.06％ (26 out of 144).There was remarkable difference between the two groups (P=0.048).But there was no significant difference on risk factors of IFD between the two groups.In addition,the incidence of liver function abnormalities between the two groups was no difference.The ratio of auditory hallucination and visual impairment induced by voriconazole was not high.Conclusions Intravenous voriconazole on primary prevention for IFD after allo-HSCT is much better than oral fluconazole with well tolerability and satisfactory efficacy.
