伏立康唑治疗慢性阻塞性肺疾病合并肺部真菌感染的临床效果及对炎性因子水平的影响分析Analysis of the clinical effects of Voriconazole in the treatment of patients with chronic obstructive pulmonary disease combined with fungal infection and its effect on the levels of inflammatory factors
张新静;陆小威;苏佳;朱际平;
摘要(Abstract):
目的探讨伏立康唑治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺部真菌感染的临床效果及对炎性因子水平的影响。方法回顾性分析宿迁市第一人民医院2016年4月至2018年4月收治的80例拟诊COPD合并肺部真菌感染患者的临床资料,将其中采用伊曲康唑治疗的40例患者纳入对照组,采用伏立康唑治疗的40例患者纳入试验组。比较两组患者临床症状好转时间,采用酶联免疫吸附测定检测两组患者治疗前后血清炎性因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素(interleukin,IL)-10、IL-4及IL-12]水平,比较两组患者临床疗效和不良反应发生情况。结果试验组患者各临床症状好转时间均显著短于对照组(P均<0.05),治疗总有效率显著高于对照组(P <0.05);两组患者不良反应总发生率比较无显著差异(P> 0.05)。治疗后试验组患者TNF-α和IL-12水平均显著低于对照组(P_均<0.05),IL-10和IL-4水平均显著高于对照组(P_均<0.05)。结论伏立康唑治疗COPD合并肺部真菌感染疗效较好,且安全性较高,在严格控制不良反应的情况下,适合推广使用。
关键词(KeyWords): 伏立康唑;感染;真菌;慢性阻塞性肺疾病;炎性因子
基金项目(Foundation): 国家自然科学基金(81774080)
作者(Authors): 张新静;陆小威;苏佳;朱际平;
参考文献(References):
- [1]龚峰,叶瑞海,林海.慢性阻塞性肺疾病患者肺部真菌感染危险因素研究[J].中华医院感染学杂志,2014,24(13):3237-3239.
- [2]Sethi S,Anzueto A,Miravitlles M,et al.Determinants of bacteriological outcomes in exacerbations of chronic obstructive pulmonary disease[J].Infection,2016,44(1):65-76.
- [3]张新,汪秀芹,王焱,等.慢性阻塞性肺疾病继发肺部真菌感染56例临床分析[J].中国综合临床,2014,30(10):1027-1030.
- [4]Miravitlles M,Anzueto A.Chronic Respiratory Infection in Patients with Chronic Obstructive Pulmonary Disease:What Is the Role of Antibiotics?[J].Int J Mol Sci,2017,18(7).pii:E1344.
- [5]陈健雄,陈应松.慢性阻塞性肺疾病合并呼吸衰竭患者发生真菌感染的相关因素分析[J].心肺血管病杂志,2016,35(6):467-468.
- [6]Pashley CH.Fungal Culture and Sensitisation in Asthma,Cystic Fibrosis and Chronic Obstructive Pulmonary Disorder:What Does It Tell Us?[J].Mycopathologia,2014,178(5-6):1-7.
- [7]陈亚红.2018年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读[J].中国医学前沿杂志(电子版),2017,9(12):15-22.
- [8]中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J].中华内科杂志,2006,45(8):697-700.
- [9]Lin E,Teng M,Limper AH.Pulmonary mucormycosis:clinical features and outcomes[J].Infection,2017,45(4):443-448.
- [10]吴驰,黄江,邹俊,等.慢性阻塞性肺疾病合并真菌感染的危险因素与预后[J].西部医学,2014,26(9):179-180.
- [11]Guinea J,Torres-Narbona M,Gijón P,et al.Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease:incidence,risk factors,and outcome[J].Clin Microbiol Infect,2010,16(7):870-877.
- [12]中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志,2007,46(11):960-966.
- [13]Su J,Liu HY,Tan XL,et al.Sputum Bacterial and Fungal Dynamics during Exacerbations of Severe COPD[J].PLoSOne,2015,10(7):e0130736.
- [14]庾胜,张碧波.两性霉素B脂质体与伏立康唑治疗侵袭性肺曲霉菌病临床对比观察[J].山东医药,2016,56(4):86-88.
- [15]严郁,徐珽,易群.伏立康唑治疗慢性阻塞性肺疾病并发肺部真菌感染29例[J].医药导报,2015,34(12):1665-1667.
- [16]Choi MJ,Won EJ,Joo MY,et al.Emergence of Voriconazoleresistant Aspergillus flavus Isolates in Korean Hospitals:Microsatellite Typing and Resistance Mechanism Analysis[J].Antimicrob Agents Chemother,2018.[Epub ahead of print]