伏立康唑治疗肝衰竭并发肺部真菌感染患者疗效初步研究

目的 分析应用伏立康唑治疗肝衰竭并发肺部真菌感染患者疗效及其安全性情况。方法 2016年2月~2018年8月我院收治的26例肝衰竭并发肺部真菌感染患者,接受伏立康唑治疗14例,接受伊曲康唑治疗12例,观察12 w。采用ELISA法检测血清白细胞介素（IL）-6和肿瘤坏死因子-α（TNF-α）水平,使用流式细胞仪检测外周血淋巴细胞亚群。结果 在治疗第4 w时,伏立康唑治疗患者血清TBIL水平为（96.2±54.3） μmol/L,显著低于伊曲康唑治疗组（178.3±89.4） μmol/L,P<0.05];伏立康唑治疗组血清IL-6水平为（11.5±6.7） pg/ml,显著低于伊曲康唑治疗组（18.5±6.8） pg/ml,P<0.05];所有患者发生真菌感染的时间为（27.21±15.96） d,其中慢加急性/亚急性肝衰竭患者发生真菌感染的时间为（17.8±6.9） d,显著早于慢性肝衰竭患者（37.2±16.4） d,P<0.05];两组生存患者外周血淋巴细胞亚群和肝肾功能变化无显著性差异（P>0.05）;两种抗真菌药物治疗均未引起严重的不良反应;在治疗12 w时,6例（42.9%）伏立康唑治疗患者生存,显著高于伊曲康唑治疗组的3例（25.0%,P<0.05）。结论 应用伏立康唑能更早、更有效地控制肝衰竭并发肺部真菌感染患者的病情,不影响肝肾功能,提高生存率,可能与及时控制感染后降低了血清细胞因子水平有关。

Application of vorionazole in the treatment of patients with liver failure complicated by pulmonary fungal infection

Objective To investigate the efficacy of voriconazole in the treatment of patients with liver failure complicated by pulmonary fungal infection（PFI）. Methods 26 patients with liver failure complicated by PFI were recruited in our hospital between February 2015 and August 2018,and 14 patients received voriconazole and 12 patients received itraconazole. All patients were followed-up for 12 weeks. Serum interleukin-6 （IL-6） and tumor necrosis factor-alpha（TNF-alpha） were detected by ELISA,and peripheral lymphocyte subsets were assayed by FC. Results At the end of 4 weeks,serum bilibubin level in patients receiving voriconazole was（96.2±54.3）μmol/L,much lower than（178.3±89.4） μmol/L,P<0.05] in itraconazole-treated patients;serum IL-6 level was （11.5±6.7） pg/ml,significantly lower than（18.5±6.8）pg/ml,P<0.05] in itraconazole-treated patients;the average time of fungal infection occurrence in all the patients was （27.21±15.96） d,while the onset of infection in patients with chronic-0n-acute liver failure was（17.8±6.9） d much earlier than（37.2±16.4）d,P<0.05] in patients with chronic liver failure;there were no significant differences as respect to the changes of peripheral blood lymphocyte subsets and liver or renal function tests;no severe untoward reaction was found after the anti-fungal therapy;at the end of 12-week followed-up,6（42.9%） out of voriconazole-treated patients,while only 3 （25.0%,P<0.05） of itraconazole-treated patients survived. Conclusion The application of voriconazole could effectively control the pulmonary fungal infection in patients with liver failure,and prolong the survival,which might be related to the inhibition of general inflammatory reaction.