卡泊芬净治疗40例恶性血液病患者合并侵袭性真菌感染临床研究

目的探讨卡泊芬净治疗恶性血液病合并侵袭性真菌感染(IFI)的疗效及安全性。方法回顾分析2010年1月至2011年12月40例接受卡泊芬净治疗(首日70 mg/d,之后50 mg/d,疗程依患者病情而定)恶性血液病患者的临床资料,观察患者的疗效和不良反应。结果 40例患者男性26例,女性14例,中位年龄38(16~72)岁。确诊患者4例,临床诊断10例,拟诊26例。血培养光滑念珠菌及热带念珠菌阳性各1例,胸腔积液培养曲霉菌阳性2例;合格痰液培养阳性10例,其中白色念珠菌4例,曲霉菌2例,光滑念珠菌2例,克柔念珠菌1例,热带念珠菌1例。40例患者中痊愈17例(42.5%),显效8例(20.0%),进步8例(20.0%),无效7例(17.5%),总有效率为62.5%。有效患者中位退热时间为4.5(1~11)d。初治组21例,有效17例,有效率为81%;挽救组19例,有效8例,有效率为42.1%。卡泊芬净治疗过程中不良反应较轻,一般经治疗可恢复。结论恶性血液病合并IFI应用卡泊芬净治疗疗效肯定,不良反应轻,可以作为IFI患者抗真菌的首选或挽救性治疗药物之一。

Clinical study of caspofungin in the treatment of invasive fungal infection in patients with hematologic malignancies

Objective To evaluate the efficacy and safety of caspofungin in the treatment of invasive fungal infection(IFI)in patients with hematologic malignancies.Methods Data of 40 hematologic malignancies patients received caspofungin(with caspofunjin at a dose of 70 mg in the first day,and then at a dose of 50 mg/d) treatment between January 2010 and December 2011 were retrospectively reviewed.Adverse events and the efficacy were investigated.Results Of the 40 patients,26 were male and 14 were female,with a median age of 38 years old.One candida glabrata and 1 candida tropical were positive(blood culture);two cases were aspergillus positive(pleural effusion culture).Ten cases of qualified sputum culture were positive,including 4 candida albicans,2 aspergillus,2 candida glabrata,1 candida krusei,and 1 candida tropical.Four cases were proven IFI and 10 probable IFI,26 possible IFI.In all 40 patients,17 cases were cured(42.5%)and 8 cases markedly improved(20.0%),8 cases were progressive(20.0%),and 7 cases were ineffective(17.5%),with an overall effective rate of 62.5%.In effectively treated patients,the median time of fever clearance was 4.5(1~11)d.In the group of initial treatment,17 cases were effective in 21 with an effective rate of 81.0%;in the saving group,8 cases were effective in 19 with an effective rate of 42.1%.In the process of caspofungin treatment,treatment-related adverse reactions were mostly treated and had recoverability.Conclusion Caspofungin may be an effective and safe drug to treat IFI in patients with hematologic malignancies,and can be used as the first choice of antifungal therapy in IFI patients.