两性霉素B治疗血液病患者粒细胞缺乏合并真菌感染111例临床分析

目的 比较两性霉素B与其脂质体治疗血液病粒细胞缺乏并发侵袭性真菌感染(IFI)在临床疗效及安全性上的差异.方法 82例IFI患者使用两性霉素B,29例IFI患者使用两性霉素B脂质体.两性霉素B的中位累计剂量为617(60～1895)mg,治疗中位时间18(7～60)d.脂质体的中位累计剂量为925(140～3420)mg,治疗中位时间13(7～50)d.结果 两性霉素B组及其脂质体组的临床总有效率分别为69%、58%,两组比较差异无统计学意义(P＞0.05).两组不良反应比较,寒战、发热的发生率分别为21%、10%,低血钾症分别为34%、14%,肝脏损害分别为22%、17%,肾脏损害分别为9%、3%.以上不良反应中除低钾血症(P=0.03)外,其他不良反应比较差异均无统计学意义(P＞0.05).结论 两性霉素B与其脂质体总体疗效相近,两性霉素B组严重不良反应发生率稍高.只要合理使用,大多数不良反应可以控制.

Clinical study of amphotericin B in the treatment of invasive fungal infection in 111 hematological disorder patients with neutrocytopenia

Objective To compare the differences in clinical therapeutic effect and safety between amphotericin B and its liposome form in treating invasive fungal infection(IFI)in hematological disorder with neutrocytopenia.Methods of 111 patients with IFI,82 were treated with amphotericin B and 29 with am photericin B liposome.The mean cumulatiye dose of amphotericin B was 617(60-1895)mg and the mean course was 18(7-60)d,and those for arnphotericin B liposome was 925(140-3420)mg and 13(7-50)d,respectively.Results The total effective rates of amphotericin B and its liposome groups were 69%and 58%.respectively(P＞0.05).The adverse effect rates of chill and fever in arnphotericin B and its liposome groups were 21%and 10%(P＞0.05),hypopotassemia 34%and 14%(P=0.03),hepatic impairment 22%and 17%(P＞0.05),and renal impairment9%and 3%,respectively(P＞0.05).Conclusion The therapeutic effect for IFI of amphotericin B and its liposome Was similar.The severe adverse reaction of amphotericin B liposome was slightlv lower than that of amphotericin B.