首页|两性霉素B脂质体挽救性治疗80例血液病患者侵袭性真菌病临床疗效分析

两性霉素B脂质体挽救性治疗80例血液病患者侵袭性真菌病临床疗效分析

Clinical efficacy and safety of liposomal amphotericin B in the salvage treatment of invasive fungal disease in patients with hematological diseases

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目的 探究两性霉素B脂质体(Liposomal amphotericin B,L-AmB)在血液病患者中挽救性治疗侵袭性真菌病(invasive fungal disease,IFD)的疗效及安全性.方法 回顾性收集既往抗真菌治疗失败后2023年6月至2023年12月期间于苏州弘慈血液病医院血液科接受L-AmB治疗的80例血液病患者资料.统计患者基本信息、临床疗效,应用Logistic回归分析影响L-AmB疗效的因素.结果 80例血液病患者中,确诊IFD9例(11.2%),临床诊断IFD43例(53.8%),拟诊IFD28例(35.0%).L-AmB挽救性治疗有效率为77.5%,中位每日剂量3(1~5)mg·kg-1·d-1,中位用药疗程14(8,25)d.多因素Logistic回归分析显示:疾病缓解状态(OR=4.337,95%CI 1.167~16.122,P=0.029)和用药疗程(OR=1.127,95%CI 1.029~1.234,P=0.010)是影响L-AmB疗效的独立因素.L-AmB相关输液反应包括发热和寒战(5.0%).低钾血症发生率为28.8%,主要为1~2级.肾毒性发生率为11.3%,主要为1~2级.结论 L-AmB治疗既往抗真菌治疗不耐受或无效的IFD患者安全有效,不良反应率低.
Objective To investigate the efficacy and safety of liposomal amphotericin B(L-AmB)for the salvage treatment of invasive fungal disease(IFD)in patients with hematological diseases.Methods Data were retrospectively collected from 80 patients with hematological issues treated with L-AmB between June 2023 and December 2023 after failure of previous antifungal therapy.Baseline patient information,clinical efficacy,and factors affecting the efficacy of L-AmB were analyzed by logistic regression.Moreover,adverse effects associated with L-AmB were evaluated.Results Among the 80 patients,9(11.2%)had proven IFD,43(53.8%)had probable IFD,and 28(35.0%)had possible IFD.The efficacy rate of L-AmB salvage therapy for IFD was 77.5%,with a median daily dose of 3(range:1-5)mg·kg-1·d-1 and a median dosing course of 14(range:8-25)days.Multivariate logistic regression analysis showed that the disease remission status(OR=4.337,95%CI 1.167-16.122,P=0.029)and duration of medication(OR=1.127,95%CI 1.029-1.234,P=0.010)were independent factors affecting the efficacy of L-AmB.The incidence of infusion reactions associated with L-AmB,including fever and chills,was 5.0%.The incidence of hypokalemia was 28.8%(predominantly grades 1-2),and the incidence of nephrotoxicity was 11.3%(predominantly grades 1-2).Conclusion L-AmB is safe and effective in the treatment of patients with IFD who are intolerant to or who have experienced no effect of previous antifungal therapy,with a low rate of adverse reactions.

Liposomal amphotericin BHematological diseasesInvasive fungal disease

吴源兵、姜珊珊、吴雅雪、刘彬、景雨童、包海燕、马骁、吴德沛、胡晓慧

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苏州弘慈血液病医院血液科,苏州 215000

苏州大学附属第一医院血液科,江苏省血液病研究所,国家血液系统疾病临床医学研究中心,苏州 215000

两性霉素B脂质体 血液病 侵袭性真菌病

苏州工业园区和合远达血液创新研究院项目临床专科人才专业能力创新应用科研项目

H221084RCLX2315016

2024

中华血液学杂志
中华医学会

中华血液学杂志

CSTPCD北大核心
影响因子:1.17
ISSN:0253-2727
年,卷(期):2024.45(7)