目的：探讨血液病并呼吸道侵袭性真菌感染的临床特征和疗效的影响因素。方法选择96例血液病合并侵袭性呼吸道真菌感染患者，根据药物治疗方法不同分为氟康唑组（n=30）、伊曲康唑组（n=45）、两性霉素组（n=21）。分析血液病合并侵袭性呼吸道真菌感染的临床表现、CT表现、微生物检查情况，比较三组临床疗效，临床疗效的影响因素、三组不良反应发生情况。结果伊曲康唑组、两性霉素组的总有效无统计学差异，但均明显高于氟康唑组（P<0.05），两性霉素组痊愈率均明显高于氟康唑组、伊曲康唑组（P<0.05）。原发病进展对临床疗效影响明显，而年龄、粒细胞缺乏期、药物治疗时间与临床疗效无明显关系。氟康唑组肝损害发生率明显高于伊曲康唑组、两性霉素组，伊曲康唑组的消化道反应发生率明显高于氟康唑组、两性霉素组，两性霉素组肾损害、寒战高热、低钾血症发生率明显高于氟康唑组、伊曲康唑组，差异有统计学意义（P<0.05）。结论血液病并呼吸道侵袭性真菌感染以肺部感染为多，病原菌多为念珠菌属，氟康唑疗效较差，而伊曲康唑或两性霉素疗效较好，但两性霉素由于不良反应较多，因此在应用时需慎重选择。%Objective To investigate the clinical features and influence factors of curative effect in blood disease com-plicated with invasive fungal infection of respiratory tract. Methods A total of 96 patients with blood disease compli-cated with invasive fungal infection of respiratory tract were selected.According to difference of drug treating methods,they were divided into fluconazole group (n=30),itraconazole group(n=45),amphotericin group(n=21). The clinical manifestations,CT performance, microorganism spection of blood disease complicated with invasive fungal infection of respiratory tract were analyzed, the clinical effect among three group were compared,influence factors about clinical efficacy were analyzed,the occurrence of adverse reaction among three groups were compared. Results The total effec-tive in itraconazole group and amphotericin group had no statistical significance.but those were obviously higher than those in fluconazole group (P<0.05).The cure rate in amphotericin group were obviously higher than those in flucona-zole group and itraconazole group(P<0.05). the progress of primary disease had obvious effects on clinical curative ef-fect. while age,agranulocytosis phase,drug treatment time had no obvious relationship with clinical curative effect. The incidence of liver damage in fluconazole group was obviously higher than that in itraconazole group and amphotericin group, The incidence of gastrointestinal reaction in itraconazole group was obviously higher than that in fluconazole group and amphotericin group. The incidence of renal injury,fever,hypokalemia in amphotericin group were obviously higher than those in fluconazole group and itraconazole group. The differences were statistically significant(P<0.05). Conclusion Blood disease complicated with invasive fungal infection of respiratory tract is mainly pulmonary infection. Pathogenic bacteria is mainly candida, the clinical effect of fluconazole is poor while clinical effect of itraconazole or amphotericin is better,but amphotericin is due to much adverse reactions,therefore,it needs to carefully select in appli-cation.
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