泊沙康唑在重型再生障碍性贫血强化 免疫抑制治疗初级预防真菌感染中的应用 [Posaconazole as primary prevention of fungal infection in intensive immunosuppressive therapy for severe aplastic anemia].

Author: 

Chen M, Zhuang JL, Duan MH, Zhang W, Li J, Zhu TN, Cai HC, Cao XX, Feng J, Yang C, Zhang Y, Zhang L, Zhou DB, Han B.
Zhonghua Xue Ye Xue Za Zhi. 2018 Feb 14;39(2):128-131.

Abstract: 

Abstract in English, Chinese

【摘要】目的评价在初治重型/极重型再生障碍性贫血(SAA/VSAA)患者抗胸腺/淋巴细胞免

疫球蛋白(ATG/ALG)联合环孢素A的强化免疫抑制治疗(1ST)中,采用泊沙康唑初级预防真菌感染的

疗效及安全性。方法回顾性分析北京协和医院2013年4月至2017年5月接受强化1ST及抗真菌初

级预防的58例SAA患者资料,根据抗真菌预防药物分为泊沙康唑预防组和对照组(伊曲康唑或氟

康唑预防),对比两组患者疾病特征、侵袭性真菌病(IFD)预防效果及药物不良反应,结果58例初治

SAA/VSAA患者中,泊沙康哇预防组20例,对照组38例(伊曲康唑预防23例,氟康唑预防15例)。两

组患者基线恃征(件别、年龄、疾病严重程度、病因、起病到治疗间隔时间、ATG/ALG种类)差异均无

统计学意义(P值均> 0.1)。泊沙康哇预防组和对照组IFD发生率分别为0和15.8% (P == 0.084),

对照组6例IFD中确诊、拟诊、未确定各2例;5例为肺部感染,1例为血流感染。在VSAA中.8例泊沙

康唑预防组患者无一例发生IFD,15例对照组患者5例发生IFD。泊沙康唑预防组未见明显不良反

应。结论在SAA/VSAA的强化1ST中,本回顾性分析结果提示采用泊沙康唑初级预防真菌感染有

效、安全,对于VSAA患者效果明显。

【关键词】贫血,再生障碍性;免疫抑制治疗;泊沙康唑

Objective: To Evaluate the efficacy and safety of posaconazole as primary prevention of invasive fungal disease (IFD) in patients with severe aplastic anemia (SAA) treated with anti-thymus/lymphocyte immunoglobulin (ATG/ALG) combined with cyclosporine intensive immunosuppressive therapy (IST). Methods: A retrospective analysis of clinical data of 58 SAA patients who received IST of anti-thymocyte immunoglobulin combining cyclosporine and antifungal prophylaxis during April 2013 to May 2017 in Peking Union Medical College Hospital was performed. The patients were divided into posaconazole prophylaxis group and the control group (itraconazole or fluconazole). The disease characteristics, IFD prevention effect and adverse drug reaction, curative effect and prognosis of the two groups were compared. Results: Posaconazole was used to prevent fungal infection in 20 patients. The other 38 patients were used as the control group. Retrospective analysis showed comparable characteristics (gender, age, disease severity, etiology, interval between the onset of disease to treatment, ATG/ALG type) of both groups. The incidence of IFD were 0 and 15.8% in posaconazole prophylaxis group and the control group, respectively (P=0.084). In the control group, there were 6 cases diagnosed as IFD. Of them, 2 were confirmed, 2 suspected and 2 not identified. Five of the 6 cases were pulmonary infection, 1 bloodstream infections. Of the 6 IFD cases, 5 were very severe aplastic anemia (VSAA). There was no obvious adverse reaction in posaconazole prophylaxis group. Conclusion: Posaconazole is safe and effective for primary prevention of fungal infection of SAA patients receiving IST, especially for the VSAA.

KEYWORDS:

Anemia, aplastic; Immunosuppressive therapy; Posaconazole