摘要
目的:探讨伏立康唑治疗超/极早产儿侵袭性真菌感染的疗效及安全性,为此类患儿抗真菌药物治疗提供参考经验.方法:回顾性分析2019年1月1日至2023年12月31日于武汉大学中南医院NICU及PICU住院治疗并诊断为侵袭性真菌感染的超/极早产儿11例,采用t检验比较治疗前后患儿白细胞计数、血小板计数、C反应蛋白、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮、肌酐水平,所有数据用SPSS 26.0软件进行统计分析.结果:11例中,其中男性患儿8例(72.7%),女性患儿3例(27.3%),超早产儿3例(27.3%),极早产儿8例(72.7%),胎龄29+3(26+5,30+5)周,体质量(1.21±0.25)kg,发病时间为出生后(40±20)d.所有患儿均予伏立康唑抗感染,治疗(4±1)d后临床表现均明显好转,实验室检查:C反应蛋白(75.5±30.0)mg/L、(18.2±5.2)mg/L(t=2.25,P<0.01),血小板计数(95±40)×10-9/L、(179±60)×10-9/L(t=3.10,P<0.05),治疗前后差异有统计学意义;白细胞计数(8.2±5.5)×10-9/L、(7.5±2.0)×10-9/L(t=1.43,P=0.23),ALT(42±8)U/L、(50±15)U/L(t=1.90,P=0.46),AST(45±11)U/L、(49±12)U/L(t=2.20,P=0.52),肌酐(27.6±9.0)μmol/L、(25.9±6.0)μmol/L(t=1.60,P=0.38),尿素氮(2.5±0.9)mmol/L、(2.8±0.4)mmol/L(t=1.20,P=0.47),治疗前后差异无统计学意义.1例患儿放弃治疗,余患儿均缓解出院.结论:伏立康唑治疗超/极早产儿侵袭性真菌感染有效、副反应少、安全性高.
Abstract
Objective:To explore the efficacy of voriconazole in the treatment of invasive fungal infections in extremely/very preterm infants,and to provide reference experience for the antifungal drug treat-ment of such children.Methods:The extremely/very preterm infants with invasive fungal infections were retrospectively studied in the NICU and PICU of Zhongnan Hospital of Wuhan University from January 1,2019,to December 31,2023.The data of basic information of the patients,clinical and laboratory results were extracted from the HIS system,and a t-test was used to compare the leuko-cytes,C-reactive protein,and platelets of the infants before and after the treatment,ALT,AST,urea nitrogen,creatinine levels,and other data were analyzed by SPSS 26.0.Results:Eleven ex-tremely/very preterm infants were hospitalized and diagnosed with invasive fungal infections were en-rolled,including 8(72.7%)males and 3(27.3%)females,3(27.3%)extremely preterm infants,and 8(72.7%)very preterm infants,with an overal gestational age of 29+3(26+5,30+5),mean body weight of(1.21±0.25)kg,and mean onset of disease of(40±20)days after birth.All the patients were treated with voriconazole for 3-7 days,and the clinical manifestations gradually disappeared.There were statistically significant changes after treatment in the serum levels of C-reactive protein,(75.5±30.0)mg/L vs(18.2±5.2)mg/L(t=2.25,P<0.01),and platelets levels,(95±40)×10-9/L vs(179±60)×10-9/L(t=3.10,P<0.05).While no statistically significant changes after treatment were found in leukocytes,(8.2±5.5)×10-9/L vs(7.5±2.0)×10-9/L(t=1.43,P=0.23),ALT,(42±8)U/L vs(50±15)U/L(t=1.90,P=0.46),AST,(45±11)U/L vs(49±12)U/L(t=2.20,P=0.52),creatinine,(27.6±9.0)μmol/L vs(25.9±6.0)μmol/L(t=1.60,P=0.38),and urea nitrogen,(2.5±0.9)mmol/L vs(2.8±0.4)mmol/L(t=1.20,P=0.47).All children were given voriconazole for anti-infection,but one of them abandoned the treatment,and the remaining children were discharged with improvement.Conclusion:Voriconazole is safe and effective in the treatment of invasive fungal infections in ultra/very preterm infants.
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