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目的探讨血液病患儿侵袭性真菌感染联合药物治疗组合及疗效。方法 2006年1月至2011年4月在中山大学孙逸仙纪念医院就诊的血液病合并侵袭性真菌感染并予以联合治疗患儿39例,对患儿的临床资料及治疗效果进行回顾性分析。结果联合抗真菌药物治疗者共48例次,其中拟诊11例次,临床诊断32例次,确诊5例次。两性霉素B联合卡泊芬净18次,无效3次;两性霉素B联合伊曲康唑静脉13次,口服4次,均有效;两性霉素B联合伏立康唑9次,无效1次;卡泊芬净联合伊曲康唑6次,无效1次;卡泊芬净联合伏立康唑5次,均有效;伊曲康唑联合制霉菌素1次,有效。完全缓解27例,部分缓解7例,放弃1例,恶化死亡4例。三唑类联合两性霉素B或卡泊芬净与两性霉素B联合卡泊芬净相比,效果差异无统计学意义(P>0.05)。结论 免疫功能明显抑制、既往侵袭性真菌感染且再次接受强化疗或造血干细胞移植、严重或突破性真菌感染、单药治疗失败或毒副反应大、合并移植物抗宿主病患儿的联合治疗疗效较满意。三唑类联合两性霉素B或卡泊芬净与两性霉素B联合卡泊芬净均可作为联合用药选择。

Combied antifungal treatment for invasive fungal infection in children with hematological diseases

Objctive To evaluate the efficacies of treating invasive fungal infection ( IFI ) with double combinations in children with hematological diseases. Methods A retrospective clinical study was made on curative effect based on 39 patients from January 2006 to April 2011. Results A total of 48 IFIs were treated with combined antifungal therapy. Among them,11 had possible diagnosis,32 probable diagnosis and 5 proven diagnosis. Eighteen IFIs received amphotericin B combined with caspofungin,3 invalid ; 13 received amphotericin B and itraconazole injection,4 oral solution,all effective ; 9 received amphotericin B and voriconazole,1 invalid ; 6 received caspofungin and itraconazole,1 invalid ; 5 received caspofungin and voriconazole,all effective. Totally 27 responded with complete remission,8 partial remission,1 abandoned,4 dead. There was no significant difference among triazole combined with amphotericin B or caspofungin and amphotericin B with caspofungin (P> 0.05 ) . Conclusion Combined antifungal therapy shows impressive curing activity on patients with severe impaired immunological function,who receive strong chemotherapy,HSCT with past history of IFI,severe or breakthrough IFI,monotherapy failure or have intolerable side effects,and those having graft-versus- host disease after HSCT. Triazole combined with amphotericin B or caspofungin and amphotericin B with caspofungin are all choice.