国产两性霉素B单用或联合其他抗真菌药治疗恶性血液病并真菌感染54例临床分析

目的探讨国产两性霉素B单药或联合其他抗真菌药物治疗恶性血液病合并侵袭性真菌病(IFD)患者的有效性、安全性。方法回顾性分析2013年4月~2016年4月我科收治的54例恶性血液病首次合并IFD患者采用国产两性霉素B及联合其他抗真菌药物的临床资料。结果 54例患者经治疗后总有效率为88.9%。两性霉素B组、两性霉素B联合伏立康唑组、两性霉素B联合卡泊芬净组有效率分别为76.2%(16/21例)、96.4%(27/28例)、100%(5/5例)。本组患者以中性粒细胞的恢复、吸烟史为主要易感因素(P0.05)。肺部CT多可见斑片状磨玻璃影63.0%(34/54例)、实变11.1%(6/54例)、结节14.8%(8/54例)。本研究主要不良反应为低钾血症、肝脏损害。结论国产两性霉素B对于恶性血液病合并IFD患者仍为经济、安全、有效的抗真菌经典药物,单药治疗效果不佳时联合其他抗真菌药物可增强疗效,虽不良反应发生率有所增加,但予治疗则可以控制,从而达到更积极的抗真菌治疗、提高治疗有效率、降低病死率的目的。     

两性霉素B联合伊曲康唑或卡泊芬净治疗恶性血液病并发侵袭性真菌感染

目的观察两性霉素B联合伊曲康唑或卡泊芬净治疗恶性血液病患者并发侵袭性真菌感染(IFI)的临床疗效及安全性。方法收集我院联合治疗患者9例,对其疗效及毒副反应进行分析研究。结果9例患者7例有效,1例无效,1例停药。低钾是最常见的副反应,其他副反应包括畏寒、发热及肝、肾功能受损。结论两性霉素B联合伊曲康唑或卡泊芬净治疗IFI,经济、有效,患者依从性较好。     

国产伏立康唑治疗侵袭性真菌感染6例临床观察

目的观察国产伏立康唑治疗恶性血液病患者侵袭性真菌感染（IFI）的临床疗效和安全性。方法以国产伏立康唑治疗6例发生于恶性血液病患者的侵袭性真菌感染,观察疗效及不良反应。结果6例患者中,有效4例,其中完全反应3例,部分反应1例。1例用药第6天出现低钾血症。结论国产伏立康唑是治疗恶性血液病患者侵袭性真菌感染的安全有效的药物,     

两性霉素B 3日加量疗法在急性白血病合并侵袭性真菌病患儿中的临床应用

目的探讨两性霉素B 3日加量疗法治疗化疗后白血病患儿侵袭性真菌病的疗效及患儿对其的耐受性。方法回顾分析2009年3月—2018年12月于我院收治的使用两性霉素B治疗的发生侵袭性真菌病的急性白血病患儿108例,根据给药方式的不同将其分为A、B两组(A组50例,B组58例);A组5日加至足量;B组3日加至足量;分析两性霉素B相关不良反应及剂量累计相关累积毒性,用药4周后评价疗效。结果 A组中确诊及临床诊断患儿治疗有效率为54.5%、B组为80.5%,差异具有统计学意义(P=0.021);两组不良反应差异无统计学意义(P0.05)。结论两性霉素B 3日加量疗法治疗侵入性真菌病更具优势,有效率明显提高,且两种给药方式不良反应无统计学差异,对于儿童白血病的侵袭性真菌感染,临床工作中可以采用两性霉素B 3日加量疗法,以期迅速达到血药浓度峰值,尽快控制症状,提高疗效。     

两性霉素B治疗侵袭性肺部真菌感染的临床分析

目的 分析两性霉素B治疗ICU内侵袭性真菌感染的疗效与不良反应.方法 回顾性分析98例合并侵袭性肺部真菌感染的重症患者接受两性霉素B微泵静脉给药的临床资料.结果 两性霉素B的临床有效率77.55％,真菌清除率75.51％.不良反应包括寒战发热（9.18％）、皮疹（4.08％）、静脉炎（1.02％）、恶心呕吐（6.12％）、低钾血症（16.32％）、肝损害（1.02％）和肾损害（4.08％）.结论 国产两性霉素B对于重症患者侵袭性真菌感染疗效确定,采用持续微泵静脉给药不良反应发生率低.     

注射用两性霉素B脂质体(锋克松)临床应用有奖征文

真菌感染一直是困扰临床医师及患者的问题,两性霉素B作为一种广谱抗真菌制剂,被誉为治疗深部真菌感染的"金标准"。但由于两性霉素B的毒副作用,因而限制了其临床的使用。而脂质体独特的靶向作用,极大的减少了其毒副作用。已经广泛应用于深部真菌感染治疗,获得较好疗效。锋克松作为注射用两性霉素B脂质体的独家国产制剂自上市以来,其确切的疗效,副作用小,为临床医师和患者都带来了更     

老年COPD患者应用卡泊芬净治疗侵袭性真菌感染的疗效与安全性分析

目的:分析老年COPD患者应用卡泊芬净治疗侵袭性真菌感染的疗效与安全性。方法:选择我院2013年1月至2015年1月收治的老年COPD合并侵袭性真菌感染患者80例,将其随机分成对照组和实验组各40例,对照组患者给予两性霉素B脂质体治疗,实验组患者给予卡泊芬净治疗。结果:实验组患者的临床治疗总有效率、不良反应发生率均显著优于对照组患者,两者比较差异有统计学意义(P0.05)。结论:卡泊芬净治疗老年COPD合并侵袭性真菌感染具有比较显著的临床疗效,而且不良反应发生率低,值得临床推广和应用。     

替考拉宁在感染的血液病患者中血药浓度的监测与应用价值分析

目的:探讨替考拉宁在感染的血液病患者中血药浓度的监测与应用价值。方法:回顾分析2017年12月-2019年12月来我院治疗的42例革兰氏阳性球菌引起感染的血液病患者临床资料,按照临床替考拉宁的给药剂量分A组和B组,每组21例。利用高效液相色谱法(HPLC)检测患者第5天用药前30 min的血药浓度,利用酶联免疫荧光法检测患者降钙素原(PCT)水平。比较两组血药浓度,临床疗效及PCT水平的差异,并记录不良反应。结果:B组患者血药浓度(15.12±4.68)mg/L高于A组的(11.76±5.31)mg/L,且B组患者PCT水平(0.86±1.21)ng/mL低于A组的(2.23±1.63)ng/mL,差异均有统计学意义(P<0.05)。B组患者临床有效率为95.24%(20/21),A组临床有效率为71.43%(15/21),两组临床有效率比较差异有统计学意义(P<0.05)。A组发生不良反应发生率为23.81%(5/21),B组不良反应发生率为19.05%(4/21),两组患者不良反应发生率比较差异无统计学意义(P>0.05)。有效组患者血药浓度(17.21±6.64)mg/L高于无效组的(10.14±5.48)mg/L;且有效组患者PCT水平(0.65±1.31)ng/mL低于无效组的(2.63±1.87)ng/mL,差异均有统计学意义(P<0.05)。结论:对感染的血液病患者,提高替考拉宁初始负荷剂量可以达到较高的有效血药浓度,临床疗效更好,且不良反应未见增加。对感染的血液病患者进行血药浓度监测,能够一定程度上反映出临床治疗效果,具有临床参考价值。     

脂质体两性霉素B的临床应用进展

脂质体两性霉素B是在两性霉素B分子的外面包裹了生物性脂质体,通过脂质体的携带可改善药物在体内的分子代谢,较多地分布在肝、脾、肺,而在肾组织中分布减少,从而显著地减少了其不良反应,使患者的耐受性提高,临床疗效也获得了提高,适用于系统性真菌病患者的治疗。现就脂质体两性霉素B的临床应用作一综述。     

腰椎置管治疗隐球菌性脑膜炎4例并文献复习

目的 观察早期腰椎置管引流加鞘内注射两性霉素B治疗伴有恶性高颅压隐球菌性脑膜炎的临床效果及探讨临床应用的可行性.方法 详细分析和归纳整理了我科应用腰椎置管法治疗的4例隐球菌性脑膜炎患者的临床资料.结果 4例患者经早期腰椎置管引流加鞘内注射两性霉素B治疗后临床症状迅速改善.经联合治疗后,痊愈3例,好转1例,4例患者随访至今均无复发.结论 早期腰椎置管引流加鞘内注射两性霉素B治疗隐球菌性脑膜炎能有效的降低隐球菌脑膜炎患者的高颅压,改善临床症状,提高疗效.     

Is There Still a Place for Conventional Amphotericin B in the Treatment of Neonatal Fungal Infections?

Neonatal invasive fungal infections (IFIs) remain an increasing problem associated with high rates of morbidity and mortality, as well as late-onset neurodevelopmental implications. Invasive candidiasis remains the leading neonatal IFI. Candida albicans is the fungal species most often affecting this population, although a changing epidemiologic incidence to non-albicans Candida species is reported in some neonatal intensive care units. Many treatment recommendations are extrapolated from adult populations, emphasizing the need to establish the optimal antifungal agent, dosage, and duration of therapy in neonates. Historically, conventional amphotericin B has been considered an efficient and safe treatment approach for most neonatal IFIs. More recently, lipid formulations of amphotericin B have been studied, used alone or in combination with other antifungal agents such as azoles or echinocandins. The aim of this article is to review the published experience in the use of amphotericin B formulations to treat neonatal IFIs.     

Amphotericin B deoxycholate for relapse visceral leishmaniasis in Bangladesh: a cross-sectional study

Objective

Based on studies in India (as there was no studies from outside India) amphotericin B deoxycholate has been considered as a backup drug for treatment of visceral leishmaniasis. However, treatment response and adverse effect to anti-leishmanial drugs may vary across different populations and in Bangladesh the effect to amphotericin B deoxycholate for treatment of visceral leishmaniasis is still unknown. Therefore, there is a need to explore cure rate and adverse effects to amphotericin B deoxycholate to justify its use on visceral leishmaniasis patients in Bangladesh.

Result

Here we report 34 visceral leishmaniasis patients who received treatment with amphotericin B deoxycholate in the Surya Kanta Kala-azar Research Centre from December 2011 to June 2015. The dose of the treatment was 1 mg/kg body weight for 15 days followed up until 12 months after treatment. Response to amphotericin B deoxycholate treatment was excellent as all 34 patients achieved a final cure. Hypokalaemia (47%), shivering (47%), vomiting (35%) and acidity (15%) were most common adverse events. However, we did not observe any serious adverse events. Amphotericin B deoxycholate for relapse visceral leishmaniasis was found to be highly effective and safe. Our study justified to include amphotericin B deoxycholate as a second line drug for visceral leishmaniasis in Bangladesh.

     

原发性血小板减少性紫癜合并侵袭性真菌感染2例报告附文献复习

目的 报道2例难治性原发性血小板减少性紫癜（ITP）患者用大剂量激素和（或）免疫抑制剂后发生侵袭性真菌感染（IFI）,其治疗经过及相关文献复习。方法 2例难治性ITP患者用大剂量激素和（或）免疫抑制剂后发生IFI,用大扶康、两性霉素B,降颅压,辅助呼吸等治疗。结果 例1发生隐球菌脑膜脑炎、例2出现肺曲酶菌感染,均经抗真菌治疗无效死亡。结论 长期应用激素及免疫抑制剂是难治性ITP患者发生IFI的危险因素,治疗困难,确诊后用药应足量、足疗程。     

Relevancia de la anfotericina B liposomal en el tratamiento de las infecciones fúngicas invasoras en pacientes oncohematológicos

Liposomal amphotericin B (L-AmB) has been a key cornerstone for the management of invasive fungal infections (IFI) caused by a wide array of molds and yeasts during the last three decades. Multiple studies performed over this period have generated a large body of evidence on its efficacy and safety, becoming the main antifungal agent in the management of IFI in patients with hematologic malignancies in several not mutually exclusive clinical settings. First, L-AmB is the most commonly used antifungal agent in patients undergoing intensive chemotherapy for acute leukemia and high-risk myelodysplastic syndrome, as well as in hematopoietic stem cell transplant recipients. Additionally, due to the administration of newer targeted therapies (such as monoclonal antibodies or small molecule inhibitors), opportunistic mold infections are increasingly being reported in patients with hematologic malignancies usually considered low-risk for IFI. These agents usually have a high drug-drug interaction potential, being triazoles, commonly used for antifungal prophylaxis, included. Finally, patients developing breakthrough IFI because of either subtherapeutic concentrations of antifungal prophylactic drugs in blood or selection of resistant strains, require broad spectrum antifungal therapy, usually with an antifungal of a different class. In both situations, L-AmB remains as the best option for early antifungal therapy.     

Posaconazole Salvage Treatment for Invasive Fungal Infection

Invasive fungal infection (IFI) is an important cause of morbidity and mortality. Posaconazole is a second generation triazole with a broad spectrum, and it may be suitable for salvage antifungal treatment although posaconazole is not usually considered to be as first-line antifungal therapy for IFI. The purpose of this study was to assess the utility of posaconazole salvage treatment for IFI. We conducted a retrospective review of patients with salvage antifungal treatment with posaconazole for IFI at our institution between December 2007 and July 2012. A total of ten patients received posaconazole salvage IFI. Etiology of IFI was consisting of mucormycosis (four patients), Paecilomyces variotii (one patient), and unspecified IFI etiology (five patients). Causes of posaconazole treatment were following; intolerance of previous antifungal therapy in five patients, refractory IFI on previous antifungal therapy in four patients, and both intolerance of previous antifungal therapy and refractory IFI on previous antifungal therapy in one patient. Duration of posaconazole salvage treatment ranged from 15 to 355 days with median 47 days. The overall successful posaconazole salvage treatment response rate was 80.0 % (8 of 10 patients). There were three patients who died during the study period. However, only one death was attributed to the progression of IFI. Two patients discontinued posaconazole due to adverse events. Posaconazole salvage treatment was effective antifungal therapy for IFI. Further studies are needed to define the optimal therapeutic strategy.     

两性霉素B联合氟胞嘧啶与伏立康唑治疗艾滋病合并隐球菌脑膜炎的临床回顾性研究

目的观察两性霉素B联合氟胞嘧啶与伏立康唑治疗艾滋病合并隐球菌性脑膜炎的疗效和安全性,探讨艾滋病合并隐球菌性脑膜炎的新型治疗策略。方法采用回顾性病例对照研究,20例艾滋病合并隐球菌脑膜炎分别接受三联治疗（两性霉素B＋氟胞嘧啶＋伏立康唑,n=10）和传统的两联治疗（两性霉素B＋氟胞嘧啶,n=10）,比较两种治疗方案在降低脑脊液中隐球菌计数的幅度以及临床症状缓解、病死率等方面的差异以及不良反应发生情况。结果治疗2周后,三联治疗患者脑脊液中隐球菌计数下降率明显高于两联治疗患者（下降率分别为0.743和0.408,P=0.009）,三联治疗患者头痛明显减轻或消失的时间短于两联治疗者（分别为12 d和20 d,P=0.009）,两组在2周、4周、8周及12周时的病死率均无统计学差异。两种治疗方案的不良反应发生率相当。结论两性霉素B联合氟胞嘧啶与伏立康唑能有效降低脑脊液中隐球菌计数,可作为艾滋病合并隐球菌脑膜炎诱导期的治疗选择。     

Amphotericin B Serum Concentrations During Therapy

Therapeutic outcome of patients being treated for systemic mycoses with amphotericin B is possibly related to the serum concentrations of this drug that are produced in these patients. Because current data are conflicting, the magnitude of these concentrations was restudied by using a bioassay which gave precise and accurate results. The highest of 155 serum concentrations was 2.01 mug/ml. Mean concentrations were 1.21, 0.62, and 0.32 mug/ml, at 1, 18, and 42 hr, respectively, after intravenous infusion of amphotericin B. This drug was detected in serum 7 weeks after completion of treatment, but it could not be detected 13 weeks after treatment. Drug levels did not appreciably decrease in serum stored for 8 to 9 months at - 10 C. Unequal serum content in assay tubes and measurement of assay turbidity by visual inspection may explain previously reported amphotericin B levels of 3.0 to 12.5 mug/ml.