卡泊芬净治疗侵袭性真菌病的临床研究

摘要

Objective To evaluate the efficacy and safety of caspofungin for the treatment of invasive fungal disease (IFD) in intensive care unit (ICU) patients. Methods The clinical data of IFD patients who were treated with caspofungin in 3 ICUs (respiratory, emergency and surgical) were retrospectively reviewed and analyzed. Results From May 2005 to November 2009, 35 patients with IFD were treated with caspofungin, including 24 males and 11 females. The mean age was (58. 3 ± 24. 1) years old. Twenty were proven cases, including 18 candidemia (10 C. Albicans, 3 C. Parapsilosis, 2 C. Glabrata, 2 C. Tropicalis and 1 C. Krusei), 2 cases of pulmonary IFD (1 C. Glabrata and 1 Aspergillus) , 5 probable pulmonary IFD cases and 10 possible pulmonary IFD cases. Twenty-five patients were post-operational (20 cardiovascular, 5 others). The remaining 10 were internal medicine patients (4 with connective tissue disease, 3 chronic pulmonary diseases and 1 adult Still's disease receiving long term steroid therapy, 2 lung cancer receiving chemotherapy). The mean duration of the caspofungin therapy was (19. 8 ± 11. 3) days. Among the 34 evaluable patients (1 died of cardiac arrest within 24 hours after the therapy and was excluded), 16 were cured (16/34, 47. 1%) , 9 were markedly improved (9/34, 26. 5%). The overall effective rate was 73. 6% (25/34). Five patients were improved and 4 failed. Thirteen patients died finally. The overall mortality rate was 37.1% (13/35). No drug-related side effect or toxicity was recorded. Conclusions Caspofungin may be an effective and safe drug to treat IFD in ICU patients, which warrants further clinical study.%目的 探讨卡泊芬净治疗侵袭性真菌病(IFD)的疗效与安全性.方法 回顾分析北京安贞医院呼吸科、急诊科和外科ICU接受卡泊芬净治疗的IFD患者临床资料.结果 2005年5月-2009年12月共35例接受卡泊芬净治疗患者.其中,确诊20例,包括念珠菌血症18例(白念珠菌10例,近平滑念珠菌3例,光滑念珠菌和热带念珠菌各2例,克柔念珠菌1例)、肺IFD 2例(光滑念珠菌和曲霉各1例);拟诊肺IFD 5例;疑似肺 IFD 10例.基础疾病为心血管手术后20例,骨科与普外科手术后各2例,产科手术后1例,间质性肺疾病4例,慢性阻塞性肺疾病3例,肺癌化疗后2例,成人Still's病1例.卡泊芬净疗程为(19.8±11.3)d,1例于用药当天死于心脏骤停疗效无法判断,34例可评估患者中,痊愈16例(16/34,47.1 %),显效9例(9/34,26.5%),总有效率73.6% (25/34),进步5例,无效4例.最终死亡13例(13/35,病死率37.1%).治疗过程中未发现与卡泊芬净有关的不良反应.结论 卡泊芬净是治疗ICU中IFD的有效、安全药物,值得进一步临床验证.