伊曲康唑联合重组人粒细胞集落刺激因子治疗中性粒细胞减少的血液病患者侵袭性真菌感染的疗效及安全性评价

目的 评价伊曲康唑联合重组人粒细胞集落刺激因子（rhG-CSF）治疗中性粒细胞减少的血液病患者合并侵袭性真菌感染的临床疗效及安全性.方法 回顾性分析2007年1月至2011年12月收治的103例血液病合并真菌感染的患者,治疗期间72例患者出现粒细胞缺乏,其中44例患者应用伊曲康唑联合rhG-CSF治疗（治疗组）,28例患者单独应用伊曲康唑治疗（对照组）.结果 治疗组患者有效率为72.73％,对照组为46.43％（P＜0.05）;中性粒细胞≤500/mm3且≥100/mm3的患者抗真菌治疗有效率明显高于中性粒细胞≤100/mm3的患者（P＜0.05）;粒缺持续时间≤10 d的抗真菌治疗有效率明显低于粒缺持续时间＜10 d的患者（P ＜0.05）;72例患者中确诊9例、临床诊断33例、拟诊30例;确诊组有效率低于临床诊断与拟诊组（P＜0.05）,抢先性治疗组（87.50％）和经验性治疗组（64.00％）的有效率均明显高于目标性治疗组（34.78％）,差异有统计学意义（P均＜0.05）.结论 伊曲康唑联合rhG-CSF治疗中性粒细胞减少的血液病患者真菌感染是有效安全的;中性粒细胞减少的程度和时间是影响真菌治疗效果的重要因素.

Evaluation of efficacy and safety of itraconazole combined with recombinant human granulocyte colony-stimulating factor in treatment of invasive fungal infections in neutropenic patients with hematological diseases

Objective To evaluate the clinical efficacy and safety of itraconazole combined with recombinant human granulocyte colony-stimulating factor （rhG-CSF） in treatment of neutropenic patients with hematological diseases who were suffering from invasive fungal infections（IFI）.Methods 103 IFI patients from Jan 2007 to Dec 2011 were retrospectively analysed and 72 patients generated agranulocytosis.44 patients were treated with itraconazole combined with rhG-CSF （treatment group） and 28 patients were treated with itraconazole alone （control group） during treatment.Results The response rate was 72.70％ in treat group and 46.40％ in control group.The effect of antifungal therapy decreased when the absolute neutrophil count declined to less than 100 cells/mm3 and increased further when the count declined to less than 500 cells/mm3 and more than 100 cells/mm3.Patients who remained neutropenic for more than 10 days were less effective than those who remained neutropenic for less than 10 days.There were 9 proven,33 probable and 30 possible patients.The effective rate of patients with proven IFI was significantly lower than patients with probable IFI and possible IFI（P ＜0.05）.The effective rate of preemptive and empirical therapy groups was equally higher than that of goal therapy group（P ＜0.05）.Condusions Itraconazole combined with rhG-CSF is safe and effective in the treatment of IFI neutropenic patients with hematological diseases.The severity and duration of neutropenia is considered a major fator for the effect of antifungal therapy.