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目的探讨两性霉素B对小儿白血病化疗后肺部侵袭性真菌感染(PIFI)的疗效。方法选取沈阳军区总医院于2012年4月至2014年8月收治的54例白血病化疗后PIFI患儿为研究对象,随机分成A、B两组,每组27例。B组采用米卡芬净,A组采用两性霉素B。对比两组临床疗效、G试验结果、肺部CT改变情况及不良反应发生率。结果 (1)A组治疗有效率为66.67%,明显优于B组的44.44%,且治疗后A组死亡6例(22.22%),低于B组的13例(48.15%),组间对比差异有统计学意义(P<0.05);(2)所有受试患儿均行动态G试验检测,发现阳性者43例(79.63%),A组22例、B组21例(P>0.05)。其中37例(86.05%)治疗后转阴,A组20例,B组17例(P>0.05);治疗前,54例患儿高分辨CT影像显示其肺部出现片状或结节状高密度影,呈现明显新月形或空洞改变;(3)治疗后,两组患者均无严重腹泻、头晕、头痛等不良反应发生(P>0.05);A组3例因耐受不足停药,B组4例因肾功能改变而停止治疗,不良反应发生对比差异无统计学意义(P>0.05)。结论对白血病化疗后出现PIFI症状的患者给予两性霉素B进行治疗,疗效显著,安全可靠,值得临床推广。
Objective To investigate the effect of amphotericin B on lung invasive fungal infection (PIFI) after chemotherapy for childhood leukemia. Methods Fifty-four children with PIFI after chemotherapy of leukemia from April 2012 to August 2014 in Shenyang Military Region General Hospital were enrolled and randomly divided into A and B groups, with 27 cases in each group. B group with micafungin net, A group with amphotericin B. The clinical efficacy, G test results, lung CT changes and the incidence of adverse reactions were compared between the two groups. Results (1) The effective rate of treatment in group A was 66.67%, which was significantly better than that in group B (44.44%). After treatment, 6 cases (22.22%) died in group A and 13 cases (48.15%) in group B, The difference was statistically significant (P <0.05). (2) All the children underwent dynamic G test and found positive in 43 cases (79.63%), 22 cases in A group and 21 cases in B group (P> 0.05) . Among them, 37 cases (86.05%) turned negative after treatment, 20 cases in group A and 17 cases in group B (P> 0.05). Before treatment, high resolution CT images of 54 children showed flakes or nodules in their lungs (3) After treatment, no serious diarrhea, dizziness, headache and other adverse reactions occurred in both groups (P> 0.05); in group A, 3 patients discontinued due to inadequate tolerance, Four patients in group B stopped treatment due to changes of renal function, and the difference in adverse reactions was not statistically significant (P> 0.05). Conclusions The treatment of amphotericin B in patients with PIFI after chemotherapy for leukemia is effective, safe, and worthy of clinical promotion.