中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2015年
11期
912-917
,共6页
邱坤银%邓兰兰%黄科%郭海霞%方建培%徐宏贵%薛红漫%黎阳%陈纯
邱坤銀%鄧蘭蘭%黃科%郭海霞%方建培%徐宏貴%薛紅漫%黎暘%陳純
구곤은%산란란%황과%곽해하%방건배%서굉귀%설홍만%려양%진순
抗真菌药物%血液病%儿童%真菌病
抗真菌藥物%血液病%兒童%真菌病
항진균약물%혈액병%인동%진균병
Antifungal agents%Hematologic Diseases%Children%Mycoses
目的 探讨儿童血液病合并侵袭性真菌病(IFD)患者联合抗真菌治疗的方案选择.方法 回顾性分析2012年1月至2014年12月住院诊断为IFD并初次接受抗真菌药物联合治疗且联合治疗持续时间≥7 d的67例血液病患儿的临床资料.联合治疗方案包括棘白菌素联合三唑类(11例)、棘白菌素联合两性霉素B(10例)、三唑类联合两性霉素B(46例).结果 67例患儿总有效率为79.1％.单因素分析显示:联合治疗期间是否有粒细胞恢复(P=0.031)、原发疾病状态(P=0.023)和联合治疗持续时间(P=0.046)显著影响联合治疗疗效.多因素分析则显示联合治疗持续时间是IFD患儿的独立预后因素(OR=0.229,95％CI 0,061～0.863,P=0.029).棘白菌素联合三唑类组、棘白菌素联合两性霉素B组和三唑类联合两性霉素B组有效率分别为81.8％、60.0％和82.6％ (P＞0.05),12周生存率分别为81.8％、80.0％和86.5％(P＞0.05).67例可评价患儿中34例(50.7％)共发生59例次联合治疗相关性不良反应,以低钾血症、尿素氮升高和肝酶增高较为常见.结论 对于血液病合并IFD患儿,延长联合治疗持续时间(≥14 d)可显著提高疗效.棘白菌素联合三唑类或两性霉素B以及三唑类联合两性霉素B均可作为联合治疗的选择.从疗效、存活率、性价比和剂型等综合考虑,三唑类联合两性霉素B是疗效好、经济安全的治疗方案.
目的 探討兒童血液病閤併侵襲性真菌病(IFD)患者聯閤抗真菌治療的方案選擇.方法 迴顧性分析2012年1月至2014年12月住院診斷為IFD併初次接受抗真菌藥物聯閤治療且聯閤治療持續時間≥7 d的67例血液病患兒的臨床資料.聯閤治療方案包括棘白菌素聯閤三唑類(11例)、棘白菌素聯閤兩性黴素B(10例)、三唑類聯閤兩性黴素B(46例).結果 67例患兒總有效率為79.1％.單因素分析顯示:聯閤治療期間是否有粒細胞恢複(P=0.031)、原髮疾病狀態(P=0.023)和聯閤治療持續時間(P=0.046)顯著影響聯閤治療療效.多因素分析則顯示聯閤治療持續時間是IFD患兒的獨立預後因素(OR=0.229,95％CI 0,061～0.863,P=0.029).棘白菌素聯閤三唑類組、棘白菌素聯閤兩性黴素B組和三唑類聯閤兩性黴素B組有效率分彆為81.8％、60.0％和82.6％ (P＞0.05),12週生存率分彆為81.8％、80.0％和86.5％(P＞0.05).67例可評價患兒中34例(50.7％)共髮生59例次聯閤治療相關性不良反應,以低鉀血癥、尿素氮升高和肝酶增高較為常見.結論 對于血液病閤併IFD患兒,延長聯閤治療持續時間(≥14 d)可顯著提高療效.棘白菌素聯閤三唑類或兩性黴素B以及三唑類聯閤兩性黴素B均可作為聯閤治療的選擇.從療效、存活率、性價比和劑型等綜閤攷慮,三唑類聯閤兩性黴素B是療效好、經濟安全的治療方案.
목적 탐토인동혈액병합병침습성진균병(IFD)환자연합항진균치료적방안선택.방법 회고성분석2012년1월지2014년12월주원진단위IFD병초차접수항진균약물연합치료차연합치료지속시간≥7 d적67례혈액병환인적림상자료.연합치료방안포괄극백균소연합삼서류(11례)、극백균소연합량성매소B(10례)、삼서류연합량성매소B(46례).결과 67례환인총유효솔위79.1％.단인소분석현시:연합치료기간시부유립세포회복(P=0.031)、원발질병상태(P=0.023)화연합치료지속시간(P=0.046)현저영향연합치료료효.다인소분석칙현시연합치료지속시간시IFD환인적독립예후인소(OR=0.229,95％CI 0,061～0.863,P=0.029).극백균소연합삼서류조、극백균소연합량성매소B조화삼서류연합량성매소B조유효솔분별위81.8％、60.0％화82.6％ (P＞0.05),12주생존솔분별위81.8％、80.0％화86.5％(P＞0.05).67례가평개환인중34례(50.7％)공발생59례차연합치료상관성불량반응,이저갑혈증、뇨소담승고화간매증고교위상견.결론 대우혈액병합병IFD환인,연장연합치료지속시간(≥14 d)가현저제고료효.극백균소연합삼서류혹량성매소B이급삼서류연합량성매소B균가작위연합치료적선택.종료효、존활솔、성개비화제형등종합고필,삼서류연합량성매소B시료효호、경제안전적치료방안.
Objective To evaluate antifungal combination strategy in children with hematologic diseases and invasive fungal disease (IFD).Methods A retrospective clinical study was performed based on 67 childhood patients with hematologic diseases and IFD who firstly accepted combination antifungal therapy for ≥7 days during January 2012 and December 2014.Of them,11 cases received combination of echinocandin with azole,10 cases received combination of echinocandin with amphotericin B,and 46 cases received combination of azole with amphotericin B.Results Overall response rate was 79.1％.Univariate analysis revealed that granulocyte recovery (P=0.031),status of underling disease (P=0.023) and the duration of the therapy (P=0.046) were significantly associated with efficacy.Multivariate analysis showed that the independent prognostic factor was the duration of combination antifungal therapy (OR=0.229,95％ CI 0.061-0.863,P=0.029).The response rates of echinocandin combined with azole,echinocandin combined with amphotericin B and azole combined with amphotericin B were 81.8％,60.0％ and 82.6％,respectively (P＞0.05),and 12-week survival rates were 81.8％,80.0％ and 86.5％,respectively (P＞0.05).The drug-related adverse reactions occurred 59 times in 34 patients.BUN increasing,hypokalemia and abnormal liver functions were considered the main side effects.Conclusions For IFD in children with hematologic disease,to extend the duration of treatment (≥14 days) could significantly improve the curative effect.Combinations of echinocandin with azole,echinocandin with amphotericin B and azole with amphotericin B can be used as a combination treatment options.Combination of Azole with amphotericin B is efficacious,safe and economic treatment option considering efficacy,survival rate,cost and dosage form.
