不同治疗策略的低剂量两性霉素B治疗恶性血液病患者侵袭性真菌病的疗效和安全

发布时间：2018-04-13 19:34

本文选题：侵袭性真菌病 + 两性霉素B　；参考：《中国实验血液学杂志》2017年01期

【摘要】：目的:分析低剂量两性霉素B(amphotericin B,AmB)在接受化疗后的恶性血液病患者不同抗真菌策略下的疗效及安全性。方法:收集2013年5月-2015年5月收治于解放军总医院应用低剂量AmB患者的病历资料,进行回顾性分析,比较各种治疗策略下的有效率,并对用药前后肾功能及电解质变化情况进行统计学分析,评价其安全性。结果:在全部97例次患者中,确诊为侵袭性真菌病(invasive fungal disease,IFD)患者2例次,临床诊断为IFD患者11例次,拟诊IFD患者15例次,未确定IFD患者69例次,低剂量AmB对全部患者的有效率为69.4%,目标治疗72.7%,诊断驱动治疗63.6%,经验治疗75%,联合其他抗真菌药物的有效率分别是50%、66.7%、75%。统计所有应用AmB患者仅有7例次(7.2%)肌酐(Cr)水平升高超过正常值上限,且均在停药7 d内恢复正常。虽然停药后1 d血清Cr水平较用药前有所增加(64.86±3.00 vs 58.76±1.67μmol/L),差异具有统计学意义(P0.05),但停药后7 d Cr水平与用药前相比无明显变化(58.43±1.68μmol/L,P0.05)。结论:应用低剂量AmB对于粒细胞缺乏而应用广谱抗生素无效的持续发热患者进行经验性或诊断驱动治疗是一种安全有效的措施。
[Abstract]:Objective: to evaluate the efficacy and safety of low dose amphotericin B(amphotericin Bmb in patients with malignant hematological diseases after chemotherapy.Methods: the medical records of patients treated with low dose AmB in PLA General Hospital from May 2013 to May 2015 were collected and analyzed retrospectively.The changes of renal function and electrolyte before and after treatment were analyzed statistically to evaluate its safety.Results: among the 97 cases, 2 cases were diagnosed as invasive fungal disease, 11 cases were diagnosed as IFD, 15 cases were diagnosed as IFD, 69 cases were diagnosed as IFD.The effective rate of low dose AmB for all patients was 69.4. The target treatment was 72.7. The diagnostic driving treatment was 63.60.The effective rate of experience therapy was 75. The effective rate of combination with other antifungal drugs was 50 and 66.775 respectively.In all patients with AmB, the creatinine creatinine (Cr) level increased more than the upper limit of the normal value and recovered within 7 days.Although the serum Cr level increased by 64.86 卤3.00 vs 58.76 卤1.67 渭 mol / L on day 1 after withdrawal, the difference was statistically significant (P 0.05), but there was no significant change in Cr level at 7 days after withdrawal compared with that before treatment (58.43 卤1.68 渭 mol / L).Conclusion: low dose AmB is a safe and effective method for the treatment of persistent fever patients with granulocytosis but no effect of broad-spectrum antibiotics.
【作者单位】：解放军总医院血液科;
【分类号】：R733;R519

【相似文献】