两性霉素B在恶性血液病合并侵袭性真菌病患者中的临床应用

 目的 分析中国人民解放军总医院恶性血液病合并侵袭性真菌病(IFD)住院患者两性霉素B的临床用药情况,为指导临床合理用药提供依据。方法 选择中国人民解放军总医院2021年1—12月血液病科和造血干细胞移植病房罹患恶性血液病合并IFD并使用两性霉素B治疗的住院患者为研究对象,分析其人口学特征、影像学检查、真菌实验室检查、两性霉素B药品的用法用量等资料。结果 共纳入131例患者,其中临床诊断26例(19.85%), 拟诊52例(39.69%),未确定53例(40.46%)。28.57%(34/119)患者(1,3)-β-D葡聚糖试验阳性,13.45%(16/119) 半乳甘露聚糖试验阳性,44.64%(50/112)患者真菌培养阳性。共培养64株真菌,以念珠菌属居多(55株)。 两性霉素B用法用量情况:111例(84.73%)患者使用两性霉素B脱氧胆酸盐(d-AmB),61例 (46.56%)患者以静脉滴注途径给药,13例(9.92%)患者使用0.9%氯化钠注射液作为溶媒,55例(41.98%)患者使用地塞米松磷酸钠作为治疗前用药。109例(83.21%)患者采用抗真菌联合用药方案,以d-AmB联合伏立康唑居多。用于静脉滴注和雾化吸入的d-AmB 药物利用指数(DUI)值均＜1.00,用于静脉滴注的两性霉素B脂质体 (L-AmB)DUI值为1.04。结论 该院两性霉素B使用合理,在溶媒的选择上还需要提高,以期获得更高的临床效益。

Clinical use of amphotericin B in patients with malignant hematological diseases combined with invasive fungal disease

Objective To analyze the clinical use of amphotericin B in hospitalized patients with malignant hematological diseases combined with invasive fungal disease (IFD) in Chinese PLA General Hospital, and provide basis for guiding rational clinical use of drugs.Methods From January to December 2021, hospitalized patients with malignant hematological diseases complicated with IFD and treated with amphotericin B in the Hematology Department and Hematopoietic Stem Cell Transplantation Ward of Chinese PLA General Hospital were selected as studied objects, and their demographic characteristics, imaging examination, fungal laboratory examination, usage and dosage of amphotericin B were analyzed.Results A total of 131 patients were enrolled, 26 cases (19.85%)were clinically diagnosed IFD, 52 cases (39.69%)were suspected, and 53 cases (40.46%)were undetermined. 28.57% (34/119) patients had positive (1,3)-beta-D-glucan assay, 13.45% (16/119) had positive Galactomannan test, and 44.64% (50/112) had positive fungal culture. A total of 64 strains of fungi were cultured, most were Candida spp. (n=55) Usage and dosage of amphotericin B: 111 cases (84.73%) were treated with amphotericin B deoxycholate (d-AmB), 61 (46.56%) were treated by intravenous drip, 13 (9.92%) were treated with 0.9% sodium chloride injection as solvent, and 55 (41.98%) were treated with dexamethasone sodium phosphate before treatment. 109 patients (83.21%) were treated with antifungal combination regimen, most were d-AmB combined with voriconazole. The drug utilization index (DUI) value of d-AmB for intravenous drip and atomization inhalation were both<1.00, and the DUI value of amphotericin B liposome (L-AmB) for intravenous drip was 1.04.Conclusion Amphotericin B is rationally used in this hospital, and the choice of solvent needs to be improved in order to obtain higher clinical benefits.