伏立康唑联合小剂量高三尖杉酯碱和格列卫治疗慢性粒细胞白血病急变期合并肺曲霉菌感染的疗效评价

目的研究伏立康唑联合小剂量高三尖杉酯碱和格列卫治疗慢性粒细胞白血病（CML）转变为急性白血病（急变期CML）合并肺曲霉菌感染（IPA）的疗效。方法选取CML急变期合并肺曲霉菌感染患者98例,随机分为观察组（49例）和对照组（49例）,两组均给予小剂量高三尖杉酯碱（HHT）和格列卫治疗;对照组加用氟康唑,观察组加用伏立康唑。结果恶性血液病疗效方面,观察组患者有效率为95.92%,对照组有效率为91.84%,两组差异无统计学意义（χ^2=0.952,P〉0.05）;IPA感染疗效方面,观察组患者有效率为81.63%,对照组有效率为65.31%,两组差异具有统计学意义（χ^2=5.137,P〈0.05）;对照组和观察组患者的不良反应发生率分别为55.10%和57.14%,差异无统计学意义（χ^2=1.037,P〉0.05）。结论伏立康唑联合小剂量的HHT和格列卫可作为治疗急变期CML合并IPA感染者一线用药方案,高效且安全。

Evaluation of voriconazole and low-dose homoharringtonine and glivec in treatment of invasive pulmonary aspergillosis in patient with chronic myeloid leukemia transformed into acute leukemia with pulmonary aspergillosis

Objective To investigate the application and evaluation of voriconazole and lowdose homoharringtonine（HHT） and glivec in treatment of invasive pulmonary aspergillosis（IPA） in patient with chronic myeloid leukemia（CML） transformed into acute leukemia with pulmonary aspergillosis（the acute phase of CML）. Methods Total of 98 patients at the acute phase of CML with IPA were selected and randomly divided into two groups. The 49 cases in observation group were treated with low-dose HHT, Gleevec treatment, fluconazole, while the 49 cases in control group were treated with low-dose HHT, Gleevec treatment and voriconazole. Results The effective rates of the observation group and the control group were 95.92% and 91.84%, respectively, with no significant differences（χ^2 = 0.952, P〈0.05）. For the treatment efficacy of IPA infection, the effective rates were 81.63% and 65.31%, respectively, with significant differences（χ^2 = 5.137, P〈0.05）. The incidence of adverse reactions of the observation group and the control group were 57.14% and 55.10%, with no significant differences（χ^2 = 1.037, P〉0.05）. Conclusions Voriconazole and low-dose HHT and glivec could used as the first-line antibiotics for the treatment of IPA patients with CML.