卡泊芬净与米卡芬净治疗恶性血液病患者侵袭性真菌病的临床应用与经济性分析

发布时间：2018-03-03 05:23

本文选题：恶性血液病　切入点：侵袭性真菌病　出处：《河北北方学院》2017年硕士论文　论文类型：学位论文

【摘要】：本文研究目的在于结合恶性血液病合并侵袭性真菌病患者的临床特点、病原学分布及影响疗效的危险因素,对卡泊芬净和米卡芬净的临床用药进行合理性与药物经济学评价分析,旨在为恶性血液病合并侵袭性真菌病的临床药物治疗提供治疗思路,并为卡泊芬净和米卡芬净的临床应用提供参考依据。研究回顾性分析了2014年1月至2015年12月某三甲医院收治的180例使用卡泊芬净或米卡芬净治疗恶性血液病合并侵袭性真菌病患者的临床资料,通过调查,汇总患者的病原学分布、感染部位、治疗效果、住院成本、影响疗效的危险因素及卡泊芬净与米卡芬净的使用情况等,同时运用SPSS 21.0软件对数据进行统计学分析以达到研究目的。研究结果显示从180例恶性血液病合并侵袭性真菌病患者的送检标本中共分离出真菌75株,主要为念珠菌属和曲霉菌属,分别占69.34%和19.33%;主要感染部位为肺部,占93.88%;治疗总有效率为44.44%,侵袭性真菌病相关死亡率为15.00%。抗真菌治疗效果与三种及以上抗菌药物联合应用及患者肝功能状况呈负相关,是影响抗真菌治疗疗效的独立因素。抗真菌药物使用过程中出现的不合理现象主要为治疗时未给予负荷剂量以及维持剂量不合理,其中卡泊芬净不合理使用率为42.74%,米卡芬净不合理使用率为5.22%;本研究中药物使用均无不良反应发生,安全性良好。药物经济学研究采用成本-效果分析法,卡泊芬净组总成本为273709.08元,米卡芬净组总成本为227156.05元;卡泊芬净组和米卡芬净组的总有效率分别为35.00%和71.67%,以总有效率为判别标准,卡泊芬净组与米卡芬净组的C/E值分别为7820.26和3169.47,以总成本较小的米卡芬净组作为参照,△C/△E为-1269.51,卡泊芬净组每下降1个疗效单位多花费1269.51元,米卡芬净组比卡泊芬净组更具成本-效果优势,是治疗恶性血液病患者侵袭性真菌病的较优药物。以上结果表明恶性血液病合并侵袭性真菌病患者感染的病原菌以白色念珠菌为主;使用三种及以上抗菌药物及肝功能不全都是影响疗效的危险因素,应当避免滥用抗菌药物,以及重视肝功能不全患者的用药合理性及安全性。卡泊芬净和米卡芬净在恶性血液病患者中的不合理使用现象较普遍,用法用量及药物相互作用等问题应当引起重视,建议加强抗真菌药物使用的监管。卡泊芬净与米卡芬净用于治疗恶性血液病合并侵袭性真菌病时,米卡芬净是较为经济有效的药物。
[Abstract]:The purpose of this study was to combine the clinical characteristics, etiological distribution and risk factors of therapeutic effects of malignant hematologic diseases with invasive mycosis. The rationality and pharmacoeconomic evaluation of carpofen and mikafenjing in clinical use were analyzed in order to provide therapeutic ideas for the treatment of malignant hematological diseases with invasive mycosis. It provides reference for the clinical application of carpofen and mikafennet. A retrospective analysis of 180 cases of malignant hematological diseases treated with carpofen or mikafennet from January 2014 to December 2015 in a third class hospital was made. Clinical data of invasive mycosis, The etiological distribution, site of infection, therapeutic effect, hospitalization cost, risk factors affecting curative effect, and the use of carbophannet and mikafennet were collected by investigation. At the same time, the data were statistically analyzed by SPSS 21.0 software. The results showed that 75 strains of fungi were isolated from 180 patients with malignant hematopathy and invasive mycosis. Candida and Aspergillus accounted for 69.34% and 19.33 respectively. The total effective rate was 44.44 and the mortality rate of invasive mycosis was 15.00. The effect of antifungal therapy was negatively correlated with the combined use of three or more antimicrobial agents and the liver function of the patients. It is an independent factor that affects the curative effect of antifungal therapy. The unreasonable phenomenon in the course of antifungal drug use is that the dose is not given load and the maintenance dose is not reasonable. The unreasonable utilization rate of carpofen was 42.74, and that of mikafennet was 5.22. In this study, no adverse drug reaction occurred and the safety was good. Cost-effect analysis was used in pharmacoeconomics. The total cost of carpofen group was 273709.08 yuan, the total cost of mikafenjing group was 227156.05 yuan, the total effective rate of carpofen group and mikafennet group was 35.00% and 71.67 respectively, and the total effective rate was regarded as the criterion. The C / E values of carpofen group and mikafenjing group were 7820.26 and 3169.47, respectively. Taking Micafenin group with lower total cost as reference, the C / E ratio was -1269.51, and the cost of each therapeutic unit decreased by 1269.51 yuan in carpofen group. Micafefen group was more cost effective than carpofen group. The above results indicate that Candida albicans is the main pathogenic bacteria in patients with malignant hematologic diseases complicated with invasive mycosis. The use of three or more antimicrobial agents and liver function are not all risk factors affecting the curative effect, and the abuse of antimicrobial drugs should be avoided. The irrational use of carpofen and mikafenin in patients with malignant hematological diseases is common, and the usage and drug interaction should be paid more attention to. It is suggested that the administration of antifungal drugs should be strengthened. When Carpofen and Micafenem are used in the treatment of malignant hematological diseases complicated with invasive fungal diseases, mikafen is a more economical and effective drug.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519;R733

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