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(P<0.05),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,P>0.05)。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。
Objective：To evaluate the efficacy and safety of low-dose amphotericin B（AmB） in different antifungal strategies for treatment of invasive fungal disease（IFD） in patients with hematologic malignancies.Metheds：The clinical dada of the patients were collected and analyzed retrospectively and the levels of creatinine（Cr）,urea nitrogen（BUN） and potassium（K＋） before and after using low-dose AmB were compared and statistically analyzed.Results：Among 97 cases,2 cases were diagnosed as invasive fungal disease（IFD）,11 cases were diagnosed as clinical probable IFD,15 cases were diagnosed as possible IFD,69 cases were undefined IFD.The response rate of all patients treated with low-dose AmB was 69.4%,the response rate for targed therapy was 72.7%,the response rate for diagnosis-driven therapy was 63.6%,the response rate of empirical therapy was 75%,the efficacy of the combination with other antibiotics was 50%,66.7%and 75%.According to all the patients received AmB,only 7 cases was detected with higher level of Cr（7.2） than normal and this level come back to normal with in 7 days after drug withdrew.Although the Cr level in serum after 1 day of drug withdrew was higher than that before administration of drug（64.86 ± 3.00 vs58.76 ± 1.67 μmol/L） and was with statistical difference（P 〈0.05）,but did not show significant difference in comparison with the level after drug withdrew 7 days（58.43 ± 1.68 μmol/L,P 〉0.05）.Conclusion：AmB injection is an effective and safe method in empirical therapy and diagnosis-driven antifungal therapy for neutropenic,febrile patients with hematological malignancies.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2017年第1期221-225,共5页
Journal of Experimental Hematology
关键词
侵袭性真菌病
两性霉素B
恶性血液病
invasive fungal disease
amphotericin B
hematological malignancy
