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目的分析伏立康唑治疗血液病侵袭性真菌感染(IFI)的疗效及安全性。方法回顾性分析32例血液病并发肺部真菌感染的患者,全部病例均应用伏立康唑静脉滴注14d后口服序贯治疗,通过临床表现和肺部影像学变化以及动态检测半乳甘露聚糖(GM)抗原等方面确定诊断和评价疗效,同时观察药物的不良反应。结果 32例肺部IFI中确诊3例,临床诊断18例,拟诊11例;全部病例均有肺部CT影像学改变,空洞及晕轮征各2例,磨玻璃改变10例,胸腔积液12例,结节影26例,其中近胸膜结节2例,近胸膜楔形病灶3例,1例合并鼻窦改变;GM试验检测32例,20例阳性,阳性率62.5%;伏立康唑治疗时间21～94d,中位治疗31d;治疗5周肺部病灶完全吸收20例,明显好转4例;32例IFI患者治愈24例,显效3例,总有效率84.4%;伏立康唑的主要不良反应为肝功能异常。结论伏立康唑是治疗侵袭性真菌感染的安全有效药物,GM试验是诊断IFI简便实用的指标。
Objective To analyze the efficacy and safety of voriconazole in the treatment of blood-borne invasive fungal infection (IFI). Methods A retrospective analysis of 32 cases of patients with blood diseases complicated with fungal pulmonary infection, all cases were treated with intravenous infusion of voriconazole 14 days after oral sequential treatment, through clinical manifestations and lung imaging changes and dynamic detection of galactomannan (GM ) Antigen, etc. to determine the diagnosis and evaluation of efficacy, while observing the adverse drug reactions. Results 32 cases were diagnosed in pulmonary IFI in 3 cases, 18 cases were diagnosed clinically and 11 cases were diagnosed. All the cases had pulmonary CT findings, 2 cases of cavities and halo signs, 10 cases of ground glass changes, 12 cases, nodules in 26 cases, including 2 cases of proximal pleural nodules, 3 cases of proximal pleural wedge lesions, 1 case of sinus changes; 32 cases of GM test, 20 cases were positive, the positive rate was 62.5%; voriconazole treatment time of 21 ~ 94d, the median treatment of 31d; 5 weeks after the treatment of lung lesions completely absorbed in 20 cases, significantly improved in 4 cases; 32 IFI patients were cured in 24 cases, markedly effective in 3 cases, the total efficiency of 84.4%; voriconazole main adverse reactions of liver dysfunction . Conclusion Voriconazole is a safe and effective drug for the treatment of invasive fungal infections. The GM test is a simple and practical indicator for the diagnosis of IFI.