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目的探讨血液病患儿侵袭性真菌感染联合药物治疗组合及疗效。方法 2006年1月至2011年4月在中山大学孙逸仙纪念医院就诊的血液病合并侵袭性真菌感染并予以联合治疗患儿39例,对患儿的临床资料及治疗效果进行回顾性分析。结果联合抗真菌药物治疗者共48例次,其中拟诊11例次,临床诊断32例次,确诊5例次。两性霉素B联合卡泊芬净18次,无效3次;两性霉素B联合伊曲康唑静脉13次,口服4次,均有效;两性霉素B联合伏立康唑9次,无效1次;卡泊芬净联合伊曲康唑6次,无效1次;卡泊芬净联合伏立康唑5次,均有效;伊曲康唑联合制霉菌素1次,有效。完全缓解27例,部分缓解7例,放弃1例,恶化死亡4例。三唑类联合两性霉素B或卡泊芬净与两性霉素B联合卡泊芬净相比,效果差异无统计学意义(P>0.05)。结论 免疫功能明显抑制、既往侵袭性真菌感染且再次接受强化疗或造血干细胞移植、严重或突破性真菌感染、单药治疗失败或毒副反应大、合并移植物抗宿主病患儿的联合治疗疗效较满意。三唑类联合两性霉素B或卡泊芬净与两性霉素B联合卡泊芬净均可作为联合用药选择。
Objective To investigate the combined treatment of invasive fungal infection and drug treatment in children with hematological diseases. Methods From January 2006 to April 2011, 39 cases of hematological diseases with invasive fungal infection were treated in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2006 to April 2011, and the clinical data and therapeutic effect were retrospectively analyzed. Results A total of 48 cases of anti-fungal drug treatment, including 11 cases were diagnosed, 32 cases of clinical diagnosis, diagnosis of 5 cases. Amphotericin B combined with caspofungin 18 times, 3 times invalid; amphotericin B combined with itraconazole vein 13 times, orally 4 times, are effective; amphotericin B combined with voriconazole 9 times, 1 times invalid; card Potenafin combined with itraconazole 6 times, 1 invalid; caspofungin combined with voriconazole 5 times, are effective; itraconazole combined with nystatin 1, effective. Complete remission in 27 cases, partial remission in 7 cases, giving up 1 case, worsening death in 4 cases. There was no significant difference in effect between triazoles combined with amphotericin B or caspofungin with amphotericin B and caspofungin (P> 0.05). Conclusions Immune function was significantly inhibited. Previous invasive fungal infection was again treated with intensive chemotherapy or hematopoietic stem cell transplantation. Severe or breakthrough fungal infection was found. Single-agent treatment failed or toxicity was high. Combined treatment of patients with graft-versus-host disease More satisfied. Triazoles combined with amphotericin B or caspofungin amphotericin B and caspofungin can be used as a combination of drug options.