【摘要】 目的评价接受异基因造血干细胞移植的再生障碍性贫血患者预处理期间应用泊沙康唑口服液预防侵袭性真菌病的疗效及安全性。方法 46例再生障碍性贫血患者接受异基因造血干细胞移植,所有患者在移植预处理期间服用泊沙康唑200 mg每日3次,直至移植后中性粒细胞植活。预防结束后1周、2周及4周复查真菌检测1,3-β-D葡聚糖检测(G试验)、半乳甘露聚糖检测(GM试验)及胸部CT,未发现真菌感染征象者,判定为真菌预防成功。结果 46例患者移植后干细胞植入前的外周血中性粒细胞绝对计数(ANC)谷值的中位数为0.02(0~0.05)×10~9/L,中性粒细胞植活的中位时间为10(8~19)d,使用泊沙康唑口服液预防性治疗的中位时间为26(15~41)d。其中45例出现了粒细胞缺乏伴发热事件,发热持续时间的中位数为5(1~13)d。其中6例(占粒细胞缺乏伴发热患者的13.3%)虽经广谱抗菌药物经验性治疗,但仍持续发热7 d以上,短期改给予静脉广谱抗真菌药的经验性治疗,后G试验、GM试验和胸部CT扫描均呈阴性结果,无一例达到侵袭性真菌病的临床诊断和确诊标准,不考虑突破,重新给予泊沙康唑口服液预防。46例患者在泊沙康唑口服液预防结束后1周、2周及4周分别行G试验、GM试验及胸部CT,均未发现真菌感染征象,可判定为真菌预防成功。无一例患者因药物不良反应停药。结论泊沙康唑口服液是预防再生障碍性贫血造血干细胞移植患者侵袭性真菌病的有效手段,安全性好,不良反应少。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of posaconazole for preventing invasive fungal disease(IFD)in the aplastic anemia patients receiving allogeneic hematopoietic stem cell transplantation(HSCT).Methods A total of 46 aplastic anemia patients received allogeneic HSCT.They were treated with oral posaconazole 200 mg,three times a day from HSCT pretreatment to granulocyte recovery after transplantation.G test and GM test were done 1,2 and 4 weeks after the end of posaconazole treatment,and chest CT scan repeated 4 weeks after the end of posaconazole treatment.Posaconazole prophylaxis was defined as successful if there were no clinical manifestations indicative of fungal infection.Results All the 46 patients experienced neutropenia.The median of absolute neutrophil count(ANC)nadir was 0.02 short-term empirical treatment with broad spectrum antifungal agents.However,subsequent G test,GM test and chest CT showed negative results.None of the six patient was consistent with IFD diagnosis.Breakthrough fungal infection was not considered.Oral posaconazole solution was resumed for preventing IFD.G test,GM test and chest CT scan did not show any sign of fungal infection1,2 and 4 weeks after the end of posaconazole prophylactic treatment in all the 46 patients,proving the success of oral posaconazole in preventing IFD.Posaconazole was not discontinued due to adverse drug reaction in any patient.Conclusions Posaconazole is effective for preventing IFD in the aplastic anemia patients receiving HSCT with good safety profile and few adverse reactions.更多还原