氟康唑预防性治疗急性再生障碍性贫血患者侵袭性真菌病的临床分析

Clinical Efficacy and Safety of the Prophylactic Treatment of Fluconazole for Acute Aplastic Anemia Patients with Invasive Fungal Disease

关键词:  侵袭性真菌病  氟康唑  再生障碍性贫血  预防性治疗

Key words:  invasive fungal disease  fluconazole  aplastic anemia  prophylactic treatment

摘要:

目的 观察氟康唑预防性治疗急性再生障碍性贫血患者合并侵袭性真菌病(invasive fungal disease，IFD)的临床疗效及安全性。方法 选择急性再生障碍性贫血合并存在IFD高危临床因素的病例作为观察对象，回顾性总结氟康唑针剂(大扶康)在预防性临床使用中的临床疗效、安全性分析、严重不良事件发生率；确立未预防治疗及预防治疗病例组，通过2组间的感染发生率、药物不良反应、治疗转归(包括粒细胞减少恢复的时间及调节性T细胞水平的纠正)、疾病预后等进行两两对照。结果及结论 使用氟康唑作为预防性抗真菌治疗的策略对于减少深部真菌感染的发生、减少患者住院周期及费用、改善患者疾病预后等有着显著意义；在用药期间，未发现氟康唑针剂相关的不良反应，具有良好的安全性。可以作为预防性用药的优先推荐药物。

Abstract:

OBJECTIVE To investigate the clinical efficacy and safety of the prophylactic treatment of fluconazole for acute aplastic anemia(AA) patients with invasive fungal disease(IFD) . METHODS Retrospectively analyzed 42 cases of the in-patients of acute aplastic anemia from September 2010 to October 2012 in the hematology department of Zhejiang Traditional Chinese Medicine Hospital, including 20 cases with the use of prophylactic treatment of fluconazole for IFD and left 22 cases without any drugs as a preventive treatment for IFD. Collected the general information of patients, blood routine, CD4T/CD8T cells, cytokines, liver and kidney function, recovery time of neutropenia, IFD occurrence and so on. RESULTS Before and after the fluconazole preventive treatment for IFD, observed the change of the percentage of CD4+/CD8+ group, and found that CD4+, CD8+ T cells were improved significantly, and the TNF-a and IL-2 levels were significantly decreased(P<0.05). But no significant difference was found in the cases without any prophylactic treatment, the level of T cells or the cytokines were improved after the treatment of AA. Compared the two groups, found that the granulocyte recovery(42 d) average time of the former was significantly shorter than the latter(76 d). CONCLUSION We are able to determine the use of fluconazole as antifungal prophylaxis strategies for reducing the incidence of deep fungal infections. During the treatment, no fluconazole injection-related adverse events were found. We recommend fluconazole as a priority prophylactic medication.