上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (4): 468-.doi: 10.3969/j.issn.1674-8115.2013.04.018

• 论著（临床研究） • 上一篇    下一篇

卡泊芬净治疗异基因造血干细胞移植术后侵袭性真菌感染

白海涛, 王 椿, 万理萍, 姜杰玲, 杨 隽, 蔡 宇   

  1. 上海交通大学附属第一人民医院血液科, 上海 200080
  • 出版日期:2013-04-28 发布日期:2013-05-03
  • 作者简介:白海涛（1975—）, 男, 主治医师, 硕士； 电子信箱: baihaitao@gmail.com。
  • 基金资助:

    上海交通大学附属第一人民医院基金（061138）

Caspofungin for treatment of invasive fungal infections after allogeneic hematopoietic stem cell transplantation

BAI Hai-tao, WANG Chun, WANG Li-ping, JIANG Jie-ling, YANG Jun, CAI Yu   

  1. Department of Hematology, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2013-04-28 Published:2013-05-03
  • Supported by:

    Foundation of the First People´s Hospital, Shanghai Jiaotong University, 061138

PDF (PC)

1128

摘要：

目的 观察卡泊芬净治疗异基因造血干细胞移植（allo-HSCT）术后患者深部真菌感染的疗效和安全性。方法 收集39例诊断为深部真菌感染的allo-HSCT术后患者，按照欧洲癌症治疗研究组织（EORTC）的诊断标准分层诊断，给予静脉卡泊芬净治疗。卡泊芬净首日负荷剂量70 mg/d，维持剂量50 mg/d，输注时间≥1 h，疗程14~42 d。患者治疗前和治疗期间每周进行影像学检查和微生物学检验；治疗后进行药物不良反应评价。结果 39例allo-HSCT术后侵袭性真菌感染患者经卡泊芬净治疗后，总有效率为76.9%（30/39）；3例确诊病例的有效率为100%（3/3），临床诊断病例有效率为73.7%（14/19），拟诊病例为76.5%（13/17）。临床诊断病例和拟诊病例的有效率比较差异无统计学意义（P>0.05）。3例患者出现轻度肝功能异常，4例出现低血钾。结论 卡泊芬净治疗真菌感染的疗效高，不良反应少，有望作为治疗allo-HSCT患者侵袭性真菌感染的一线用药。

关键词: 卡泊芬净, 异基因造血干细胞移植, 侵袭性真菌感染

Abstract:

Objective To investigate the efficacy and safety of Caspofungin for the treatment of invasive fungal infections after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Thirtynine cases of invasive fungal infections after allo-HSCT were selected, stratified diagnosis was made according to the standard of European Organization for Research on Treatment of Cancer (EORTC), and treatment with intravenous Caspofungin was performed. The initial dosage and maintenance dosage were 70 mg/d and 50 mg/d respectively, with time of infusion more than 1 h and course of treatment ranging from 14 d to 42 d. Imaging and microbiological examinations were carried out weekly before treatment and in the course of treatment. Side effects were assessed after treatment. Results The overall favorable response to Caspofungin was 76.9% (30/39). The response rates of confirmed cases, clinically diagnosed cases and suspected cases were 100% (3/3), 73.7% (14/19) and 76.5% (13/17) respectively. There was no significant difference in the response rates between clinically diagnosed cases and suspected cases (P>0.05). Three cases had mild liver function abnormalities, and hypokalemia occurred in 4 cases. Conclusion Caspofungin is an effective agent with minimal adverse effects for treatment of invasive fungal infections after allo-HSCT.

Key words: Caspofungin, allogeneic hematopoietic stem cell transplantation, invasive fungal infections