两种药物对儿童急性白血病合并真菌感染的临床疗效观察
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摘要
目的探讨泊沙康唑和伊曲康唑预防及治疗儿童急性白血病合并侵袭性真菌感染的疗效。方法回顾性分析接受常规化疗的57例白血病患儿,分别应用口服伊曲康唑及泊沙康唑预防及治疗侵袭性真菌感染,分别对两组的不良反应及临床疗效进行比较。结果泊沙康唑组CR率和总有效率均高于伊曲康唑组,但差异无统计学意义(P>0.05);泊沙康唑组不良反应发生率较伊曲康唑组增高,差异无统计学意义(P>0.05),具体不良反应方面,泊沙康唑组肝功能损害发生率明显高于伊曲康唑组,差异有统计学意义(P<0.05),而在神经毒性、视觉障碍、肾功能损害及消化道反应方面,两组间差异无统计学意义(P>0.05)。结论泊沙康唑预防及治疗侵袭性真菌感染有效率高于伊曲康唑,其肝功能损害的不良反应同时也高于伊曲康唑。
Objective To investigate the clinical efficacy of posaconazole and itraconazole in the prevention and treatment of acute leukemia with fungal infection in children. Methods A total of 57 child acute leukemia datas with regular chemotherapy were recruited in this regression analysis. Itraconazole and posaconazole were orally administered by child patients of the 2 groups,and then the differences in adverse effect and clinical efficacy between the 2 groups were compared. Results The CR rate and overall efficacy in posaconazole group were higher than those of itraconazole group,but the difference was not statistically significant( P > 0. 05);the adverse effect incident rate was higher in posaconazole group with no significant difference( P > 0. 05);for specific adverse effects,the hepatic function damage caused by posaconazole was significantly higher than itraconazole,and the difference was statistically significant( P < 0. 05);no significant difference was observed in neurotoxicity,paropsia,renal function damage and gastrointestinal reaction( P > 0. 05). Conclusion Posaconazole has better performance than itraconazole in preventing and treating invasive fungal infection,meanwhile,the adverse effect caused by posaconazole,hepatic function damage,is also higher than itraconazole.
Objective To investigate the clinical efficacy of posaconazole and itraconazole in the prevention and treatment of acute leukemia with fungal infection in children. Methods A total of 57 child acute leukemia datas with regular chemotherapy were recruited in this regression analysis. Itraconazole and posaconazole were orally administered by child patients of the 2 groups,and then the differences in adverse effect and clinical efficacy between the 2 groups were compared. Results The CR rate and overall efficacy in posaconazole group were higher than those of itraconazole group,but the difference was not statistically significant( P > 0. 05);the adverse effect incident rate was higher in posaconazole group with no significant difference( P > 0. 05);for specific adverse effects,the hepatic function damage caused by posaconazole was significantly higher than itraconazole,and the difference was statistically significant( P < 0. 05);no significant difference was observed in neurotoxicity,paropsia,renal function damage and gastrointestinal reaction( P > 0. 05). Conclusion Posaconazole has better performance than itraconazole in preventing and treating invasive fungal infection,meanwhile,the adverse effect caused by posaconazole,hepatic function damage,is also higher than itraconazole.
引文
[1]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童侵袭性肺部真菌感染诊治指南(2009版)[J].中华儿科杂志,2009,47(2):96-98.
[2]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)[J].中华内科杂志,2010,49(5):451-454.
[3]O'Connor D,Bate J,Wade R,et al.Infection-related mortality in children with acute lymphoblastic leukemia:an analysis of infectious deaths on UKALL2003[J].Blood,2014,124(7):1056-1061.
[4]杨尚伦.急性淋巴细胞白血病真菌感染临床特点分析[J].实用癌症杂志,2014,29(9):1182-1184.
[5]Park WB,Cho JY,Park SI,et al.Effectiveness of increasing the frequency of posaconazole syrup administration to achieve optimal plasma concentrations in patients with haematological malignancy[J].Int J Antimicrob Agents,2016,48(1):106-110.
[6]Maertens J,Marchetti O,Herbrecht R,et al.European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients:summary of the ECIL3--2009 update[J].Bone Marrow Transplant,2011,46(5):709-718.
[7]Flores VG,Tovar RM,Zaldivar PG,et al.Meningitis due to Cryptococcus neoformans:treatment with posaconazole[J].Curr HIV Res,2012,10(7):620-623.
[8]Al-Hatmi AM,Normand AC,Ranque S,et al.Comparative Evaluation of Etest,EUCAST,and CLSI Methods for Amphotericin B,Voriconazole,and Posaconazole against Clinically Relevant Fusarium Species[J].Antimicrob Agents Chemother,2016,61(1):e01671.
[9]Ferreira GF,Santos JR,Costa MC,et al.Heteroresistance to Itraconazole Alters the Morphology and Increases the Virulence of Cryptococcus gattii[J].Antimicrob Agents Chemother,2015,59(8):4600-4609.
[10]Zhao YJ,Khoo AL,Tan G,et al.Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole,Itraconazole,Posaconazole,and Voriconazole in Invasive Fungal Infection Prophylaxis[J].Antimicrob Agents Chemother,2015,60(1):376-386.
[11]Peterson L,Ostermann J,Rieger H,et al.Posaconazole prophylaxis--impact on incidence of invasive fungal disease and antifungal treatment in haematological patients[J].Mycoses,2013,56(6):651-658.
[2]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)[J].中华内科杂志,2010,49(5):451-454.
[3]O'Connor D,Bate J,Wade R,et al.Infection-related mortality in children with acute lymphoblastic leukemia:an analysis of infectious deaths on UKALL2003[J].Blood,2014,124(7):1056-1061.
[4]杨尚伦.急性淋巴细胞白血病真菌感染临床特点分析[J].实用癌症杂志,2014,29(9):1182-1184.
[5]Park WB,Cho JY,Park SI,et al.Effectiveness of increasing the frequency of posaconazole syrup administration to achieve optimal plasma concentrations in patients with haematological malignancy[J].Int J Antimicrob Agents,2016,48(1):106-110.
[6]Maertens J,Marchetti O,Herbrecht R,et al.European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients:summary of the ECIL3--2009 update[J].Bone Marrow Transplant,2011,46(5):709-718.
[7]Flores VG,Tovar RM,Zaldivar PG,et al.Meningitis due to Cryptococcus neoformans:treatment with posaconazole[J].Curr HIV Res,2012,10(7):620-623.
[8]Al-Hatmi AM,Normand AC,Ranque S,et al.Comparative Evaluation of Etest,EUCAST,and CLSI Methods for Amphotericin B,Voriconazole,and Posaconazole against Clinically Relevant Fusarium Species[J].Antimicrob Agents Chemother,2016,61(1):e01671.
[9]Ferreira GF,Santos JR,Costa MC,et al.Heteroresistance to Itraconazole Alters the Morphology and Increases the Virulence of Cryptococcus gattii[J].Antimicrob Agents Chemother,2015,59(8):4600-4609.
[10]Zhao YJ,Khoo AL,Tan G,et al.Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole,Itraconazole,Posaconazole,and Voriconazole in Invasive Fungal Infection Prophylaxis[J].Antimicrob Agents Chemother,2015,60(1):376-386.
[11]Peterson L,Ostermann J,Rieger H,et al.Posaconazole prophylaxis--impact on incidence of invasive fungal disease and antifungal treatment in haematological patients[J].Mycoses,2013,56(6):651-658.