初治急性白血病应用氟康唑预防真菌感染的临床观察

目的观察氟康唑在初治急性白血病（AL）患者粒细胞缺乏期预防真菌感染的疗效。方法回顾性分析本院2007年1月～2013年1月住院的58例初治AL患者,将其分为治疗组与对照组,治疗组给予氟康唑胶囊100mrCd,口服．自化疗开始至脱离粒细胞缺乏时停止;对照组未常规应用预防性抗真菌治疗。观察两组患者真菌感染率的差异。结果治疗组化疗后并发真菌感染率为7．4％（2／27）,对照组并发真菌感染率为29．0％（9／31）,差异有统计学意义（P〈0．05）。结论氟康唑预防性治疗对于预防初治AL患者真菌感染有显著疗效。     

伏立康唑预防血液病患者侵袭性真菌感染的疗效与安全性

目的评价伏立康唑预防血液病患者化疗或造血干细胞移植(HSCT)后侵袭性真菌感染的有效性及安全性。方法检索Cochrane图书馆、Medline、Em-base、Pubmed、CBM、CNKI、维普、万方等文献数据库,用RevMan 5.1进行meta分析。结果纳入研究4项,共1372例患者,伏立康唑组的真菌感染发生率、曲霉感染率分别低于氟康唑组、对照组;而总死亡率、念珠菌感染率与对照组无显著性差异;伏立康唑的胃肠道不良反应发生率低于伊曲康唑,视觉障碍和肝功异常发生率高于伊曲康唑。结论伏立康唑预防血液病患者化疗或HSCT后侵袭性真菌感染的总体疗效优于氟康唑,与伊曲康唑相当,在预防侵袭性曲霉感染中优于氟康唑和伊曲康唑,但应警惕其引起视觉障碍和肝功异常。     

复方氟康唑含漱液预防白血病患者化疗后口腔真菌感染的临床效果

目的 探讨复方氟康唑含漱液预防白血病患者化疗后口腔真菌感染的临床疗效.方法 将120例接受化疗的白血病患者,随机分成试验组和对照组各60例.试验组用复方氟康唑含漱液含漱,对照组用0.9%氯化钠注射液含漱,用法用量同试验组,2组疗程与化疗疗程同步.观察2组口腔真菌感染发生情况.结果 试验组无一例口腔真菌感染发生,对照组中10例（16.7%）口腔黏膜或舌苔涂片找到真菌,试验组口腔真菌感染发生率低于对照组,差异有统计学意义（P〈0.05）.结论 白血病患者化疗后应用复方氟康唑含漱液,可有效预防口腔真菌感染,且安全性好.     

血液病化疗后并发严重肺部感染的临床分析

目的探讨血液病患者化疗后并发严重肺部感染的危险因素。方法回顾性研究116例接受化疗的血液病患者。结果 116例患者中有11例并发严重肺部感染,发病率为9.48%,粒细胞缺乏≥7d患者中,严重肺部感染发生的发病率为12.50%,并发真菌感染的患者中,严重肺部感染的发病率为4.28%。结论粒细胞缺乏≥7d、真菌感染是血液病患者化疗后并发严重肺部感染的危险因素。粒细胞缺乏≥7d、真菌感染预后差,粒细胞恢复正常者预后良好。     

氟康唑预防性治疗急性再生障碍性贫血患者侵袭性真菌病的临床分析

目的观察氟康唑预防性治疗急性再生障碍性贫血患者合并侵袭性真菌病(invasive fungal disease,IFD)的临床疗效及安全性。方法选择急性再生障碍性贫血合并存在IFD高危临床因素的病例作为观察对象,回顾性总结氟康唑针剂(大扶康)在预防性临床使用中的临床疗效、安全性分析、严重不良事件发生率;确立未预防治疗及预防治疗病例组,通过2组间的感染发生率、药物不良反应、治疗转归(包括粒细胞减少恢复的时间及调节性T细胞水平的纠正)、疾病预后等进行两两对照。结果及结论使用氟康唑作为预防性抗真菌治疗的策略对于减少深部真菌感染的发生、减少患者住院周期及费用、改善患者疾病预后等有着显著意义;在用药期间,未发现氟康唑针剂相关的不良反应,具有良好的安全性。可以作为预防性用药的优先推荐药物。     

复方阿胶浆对恶性肿瘤化疗后白细胞减少症的临床观察

目的：观察复方阿胶浆对恶性肿瘤化疗后白细胞减少症的疗效。方法：经病理学与细胞学诊断为恶性肿瘤住院化疗白细胞减少症患者60例,随机分为治疗组30例,对照组30例,两组均按常规的化疗方案进行治疗,治疗组在化疗的同时服用复方阿胶浆,3次/d,每次40ml,每日3次,连续服用。结果：治疗组和对照组近期有效率分别为83.3%、53.3%,治疗组治疗前后白细胞和中性粒细胞数比较,差异有统计学意义（P〈0.05）;治疗组和对照组的治疗后白细胞和中性粒细胞数比较,差异有统计学意义（P〈0.05）。结论：复方阿胶浆能改善恶性肿瘤患者白细胞减少症。     

氟康唑在预防早产儿真菌感染中的临床意义

目的：探讨口服氟康唑在预防出生胎龄≤32周和/或出生体质量≤1 500 g的早产儿真菌感染中的临床意义。方法：选择2012年2月至2014年12月在本院新生儿重症监护室（NICU）分娩后收治的早产儿118例,其中未预防性给予氟康唑的早产儿（对照组）56例,预防性给予氟康唑的早产儿（预防组）62例,分析比较两组患儿的临床特点及真菌感染的发生情况,同时监测两组患儿的生化指标,观察氟康唑口服治疗有无肝肾损害,并记录早产儿视网膜病（ROP）、支气管肺发育不良（BPD）、新生儿坏死性小肠结肠炎（NEC）、脑损伤、出院时体质量、住院时间、住院费用等相关情况。结果：预防组发生真菌感染率明显低于对照组,差异有统计学意义（x2=10.59,P<0.01);预防组病死率、NEC发生率低于对照组,住院时间较短、费用少,但与对照组比较差异无统计学意义（P均>0.05）;两组ROP发生率、BPD发生率、脑损伤发生率、出院时体质量等方面比较差异无统计学意义（P均>0.05）;动态监测预防组患儿无明显肝肾损害。结论：采用口服氟康唑预防早产儿真菌感染安全、有效,值得临床推广。     

氟康唑对极低体重儿感染侵袭性真菌预防性使用的临床观察

目的:探讨分析小剂量氟康唑在极低出生体重儿侵袭性真菌感染预防中的临床作用.方法:选取2014年10月~2015年12月我院新生儿科极低出生体重儿60例为试验组,均在出生3d内给予预防性静脉应用氟康唑3mg/(kg·d),2次/周,疗程4周.同期入院低体重患儿68例为对照组,出生后仅给予抗感染、监护、保暖及营养支持治疗,但未预防性应用抗真菌药物.比较两组住院期间侵袭性真菌感染及药物不良反应发生率.结果:两组机械通气时间、中心静脉置管时间、肠外营养时间、抗生素使用时间以及住院时间比较均无显著差异(P>0.05).住院期间对照组发生侵袭性真菌感染7例(10.3%),试验组则为1例(1.7%),试验组侵袭性真菌感染发生率显著低于对照组(P<0.05).两组用药期间谷丙转氨酶、谷草转氨酶、胆红素水平及消化不良发生率均无显著差异(P>0.05).结论:对于极低出生体重儿,早期给予小剂量氟康唑可有效预防侵袭性真菌感染,具有较好的使用安全性.     

小剂量氟康唑预防早产儿经外周穿刺中心静脉置管(PICC)时真菌感染的临床观察

目的观察小剂量氟康唑预防早产儿经外周穿刺中心静脉置管(PICC)时侵袭性真菌感染临床观察。方法采用回顾性对照分析的方法,选取2012年1月至2016年1月出生于我院并在我院新生儿重症监护病房住院早产儿,胎龄28~32周,出生体质量<1500 g 178例放置PICC的早产儿为研究对象。其中随机抽取90例给予氟康唑3 mg/(kg·d)静脉滴注预防真菌感染为预防组,未给予氟康唑为对照组。比较分析真菌感染的发生率。结果对照组与预防组患儿的基本临床特点及侵袭性真菌感染的危险因素类似。90例预防组患儿中侵袭性真菌感染发生率1.1%,而对照组88例中侵袭性真菌感染发生率7.95%,两组比较有统计学意义(P<0.05)。在预防用药后2周、4周比较两组肝功能指标,无差异。结论小剂量氟康唑可有效降低早产儿PICC时侵袭性真菌感染发生,临床安全性较好。     

预防性糖皮质激素对实体瘤患者化疗后粒细胞减少的影响

目的分析研究预防性糖皮质激素对实体瘤患者化疗后粒细胞减少的影响。方法随机选取2011年5月至2014年5月于本院就诊的80例实体瘤患者为研究对象,并将其随机分为对照组(n=40)及观察组(n=40);对照组患者进行常规治疗,观察组患者则在对照组的治疗基础上预防性加用糖皮质激素。结果观察组化疗后其粒细胞Fas表达明显高于化疗前(P<0.05),但粒细胞计数以及凋亡率未有明显变化(P>0.05);对照组化疗后其粒细胞Fas表达以及凋亡率均明显高于化疗前,粒细胞计数明显低于化疗前,组内对比结果显示具有统计学意义(P>0.05);观察组化疗后其粒细胞Fas、粒细胞计数以及凋亡率均明显优于对照组,两组数据的对比结果显示差异具有统计学意义(P<0.05)。结论预防性糖皮质激素可在一定程度上影响化疗药物对于中性粒细胞凋亡诱导作用,从而降低中性粒细胞数目的减少,故具有临床推广应用价值。     

Cost effectiveness of itraconazole in the prophylaxis of invasive fungal infections

BACKGROUND: Invasive fungal infections in neutropenic patients treated for haematological malignancies are associated with a high mortality rate and, therefore, require early treatment. As the diagnosis of invasive fungal infections is difficult, effective antifungal prophylaxis is desirable. So far, fluconazole has been the most commonly used. OBJECTIVE: To assess the cost effectiveness of itraconazole compared with both fluconazole and no prophylaxis for the prevention of invasive fungal infections in haematological patients, mean age 51 years, in Germany and The Netherlands. STUDY DESIGN: We designed a probabilistic decision model to fully incorporate the uncertainty associated with the risk estimates of acquiring an invasive fungal infection. These risk estimates were extracted from two meta-analyses, evaluating the effectiveness of fluconazole and itraconazole and no prophylaxis. The perspective of the analysis was that of the healthcare sector; only medical costs were taken into account. All costs were reported in euro, year 2004 values.Cost effectiveness was expressed as net costs per invasive fungal infection averted. No discounting was performed, as the model followed patients during their neutropenic period, which was assumed to be less than 1 year. RESULTS: According to our probabilistic decision model, the monetary benefits of averted healthcare exceed the costs of itraconazole prophylaxis under baseline assumptions (95% CI: from cost-saving to euro 5000 per invasive fungal infection averted). Compared with fluconazole, itraconazole is estimated to be both more effective and more economically favourable, with a probability of almost 98%. CONCLUSIONS: In specific groups of neutropenic patients treated for haematological malignancies, itraconazole prophylaxis could potentially reduce overall healthcare expenditure, without harming effectiveness, in settings where fluconazole is common practice in the prophylaxis of invasive fungal infections.     

卡泊芬净与氟康唑治疗重症监护病房严重肺部真菌感染比较

目的:比较卡泊芬净与氟康唑治疗重症监护病房严重肺部真菌感染的有效性和安全性。方法:重症监护病房确诊的严重肺部真菌感染患者36例,随机分为2组,卡泊芬净组(18例)首剂使用70mg,以后50mg.d-1,加入250mL生理盐水中静脉滴注,时间>1h,治疗时间14d;氟康唑组(18例)400mg.d-1,静脉滴注,治疗时间14d。观察2组的疗效和不良反应。结果:卡泊芬净组有效率达100.0%,不良反应发生率为22.2%;氟康唑组有效率为66.7%,不良反应发生率为72.2%。2组有效率有显著性差异(P<0.05),卡泊芬净组不良反应发生率显著低于氟康唑组(P<0.05)。结论:对重症监护病房严重肺部真菌感染,卡泊芬净的有效性和安全性优于氟康唑。     

Clinical experience with itraconazole in systemic fungal infections

The broad spectrum antifungal itraconazole is an effective and well tolerated agent for the prophylaxis and treatment of systemic fungal infections. The recent development of an itraconazole oral solution and an intravenous itraconazole solution has increased the options for the use of this drug and increased the oral bioavailability in a variety of at-risk patients. Reliable absorption of the itraconazole oral solution has been demonstrated in patients with HIV infection, neutropenic patients with haematological malignancy, bone marrow transplant recipients and neutropenic children. In clinical trials, itraconazole oral solution (5 mg/kg/day) was more effective at preventing systemic fungal infection in patients with haematological malignancy than placebo, fluconazole suspension (100 mg/day) or oral amphotericin-B (2 g/kg/day) and was highly effective at preventing fungal infections in liver transplant recipients. There were no unexpected adverse events with the itraconazole oral solution in any of these trials. In addition, intravenous itraconazole solution is at least as effective as intravenous amphotericin-B in the empirical treatment of neutropenic patients with systemic fungal infections, and drug-related adverse events are more frequent in patients treated with amphotericin-B. A large proportion of patients with confirmed aspergillosis also respond to treatment with intravenous itraconazole followed by oral itraconazole. The new formulations of itraconazole are therefore effective agents for prophylaxis and treatment of most systemic fungal infections in patients with haematological malignancy.     

The prophylactic effectiveness of various antifungal agents against the progression of trichosporonosis fungemia to disseminated disease in a neutropenic mouse model

Neutropenic mice with latent trichosporonemia were given various antifungal agents (amphotericin B, fluconazole, itraconazole) or saline to determine which antifungal agent could be useful for prophylaxis. The 3-week-survival rate was 80% in the fluconazole group, 50% in the amphotericin B group, 45% in the itraconazole group, and 30% in the saline group. Compared with the other antifungal agents, fluconazole offered superior prophylaxis against the progression of trichosporonosis fungemia to disseminated disease (P<0.05). These results suggest that clinical studies are warranted to investigate fluconazole prophylaxis of trichosporonosis progression in neutropenic patients, such as people receiving chemotherapy and patients who have received solid organ transplants.     

Fluconazole for antifungal prophylaxis in chemotherapy-induced neutropenia.

Fluconazole is compared with other agents for antifungal prophylaxis in patients with chemotherapy-induced neutropenia. Fluconazole is an attractive alternative for antifungal prophylaxis because of its activity against many Candida species, long half-life, good patient tolerability, and minimal associated toxicity. The results of clinical trials suggest that fluconazole is superior to placebo and oral polyenes in preventing superficial fungal infection in neutropenic patients; however, its efficacy against systemic infection is not as strongly supported. Fluconazole use may increase emergence of resistant yeasts, particularly Candida krusei and Torulopsis glabrata. The cost of fluconazole 50 mg/day is similar to the costs of other antifungals used for prophylaxis; however, fluconazole 400 mg/day (the most frequently studied dose in neutropenic patients) is considerably more expensive. Comparative clinical trials between fluconazole and other antifungals are needed to determine which is superior for prophylaxis. Fluconazole is effective for prophylaxis against superficial fungal infection and may be an attractive alternative therapeutic regimen in patients undergoing bone marrow transplantation. In other neutropenic patients, such as those with leukemia, the superiority of fluconazole has not been substantiated; therefore, it is not recommended over other agents, such as clotrimazole and ketoconazole, at this time.     

伊曲康唑预防血液病患者侵袭性真菌感染疗效的Meta分析

目的:系统评价伊曲康唑预防血液病患者化疗或造血干细胞移植(HSCT)后侵袭性真菌感染的有效性。方法:计算机检索Cochrane图书馆、Medline、EMbase、PubMed、中国生物医学文献光盘数据库(CBM)、中国科技期刊全文数据库(CNKI)、维普电子期刊全文数据库、万方数据库等,并手工检索相关会议的论文集,采用RevMan5.1软件进行Meta分析。结果:纳入14项研究,共4020例患者。Meta分析结果显示,伊曲康唑组真菌感染发生率和曲霉检出率均低于氟康唑组[OR=0.72,95%C(I0.54,0.96),P=0.02;OR=0.60,95%CI(0.39,0.93),P=0.02],高于泊沙康唑组[OR=4.90,95%CI(1.58,15.15),P=0.006;OR=14.25,95%CI(2.69,75.34),P=0.002],而与两性霉素B、卡泊芬净、伏立康唑组比较差异均无统计学意义。伊曲康唑组的总死亡率、念珠菌检出率与各对照组比较差异亦无统计学意义。结论:伊曲康唑预防血液病患者化疗或HSCT后侵袭性真菌感染优于氟康唑,较泊沙康唑差,与两性霉素B、伏立康唑、卡泊芬净等相当。     

Fluconazole versus amphotericin B for the prevention of fungal infection in neutropenic patients with hematologic malignancy.

Effective prophylaxis against fungal infection is important in neutropenic patients with hematologic malignancies, but the best method remains unclear. We investigated the effectiveness of fungal prophylaxis with amphotericin B or fluconazole. We reviewed the data on fungal isolates, plasma (1-->3)-beta-D glucan (beta-D glucan) levels, febrile periods (the number of days with an axillary temperature > 38 degrees C), and the duration of an axillary temperature > 38 degrees C when the neutrophil count was < 500/microliter. Of the 124 patients studied, 57 had acute myelogenous leukemia, 19 had acute lymphoblastic leukemia, 18 had non-Hodgkin's lymphoma, six had chronic myeloid leukemia, three had adult T-cell leukemia, and five had chronic lymphocytic leukemia. There were no significant differences in clinical characteristics between the 70 patients treated with amphotericin B and the 54 patients given fluconazole. There was a significant decrease of fungal isolates (chi 2-test, p < 0.001), the plasma beta-D glucan level (Wilcoxon test, p = 0.0001), and the febrile period (t-test, p < 0.05) in the patients given fluconazole compared with those given amphotericin B. In neutropenic patients with hematologic malignancies, prophylaxis with fluconazole significantly decreased fungal isolation and other indicators of fungal infection when compared with amphotericin B. Fluconazole may therefore be more effective for fungal prophylaxis in these patients.     

氟康唑预防留置导尿管病人的尿路真菌感染

目的：研究氟康唑对重症监护室（ Ｉ Ｃ Ｕ） 病人尿路真菌感染的预防作用。方法：留置导尿的颅脑外伤和脑血管意外病人１３０ 例分为３ 组：对照组（４２例） ,不给抗真菌药物;氟康唑５０ ｍ ｇ 组（４９ 例） ,用氟康唑５０ ｍｇ ,ｑｄ , 始于置管后（２ ．８ ±１ ．２） ｄ ; 氟康唑１００ ｍｇ 组（３９ 例） ,用１００ ｍ ｇ ,ｑｄ , 始于置管后（２ ．７ ±１ ．３） ｄ 。氟康唑均由胃管注入或口服。每周作１ 次尿真菌培养等检查。结果：对照组ｗ ｋ １ ,２ ,３ 尿路真菌感染率分别为６２ ％ ,８３ ％ 和８５ ％ ;氟康唑５０ ｍｇ 组分别为４３ ％ ,３５ ％ 和１４ ％ 。１００ ｍｇ 组分别为３６ ％ ,２９ ％ 和２２ ％ 。２ 用药组ｗｋ ２ , ３ 的感染率显著降低（ Ｐ＜ ０ ．０１） 。结论：氟康唑（５０ ｍ ｇ 或１００ ｍｇ ,ｑｄ） 能安全有效地预防 Ｉ Ｃ Ｕ 病人尿路真菌感染。