两性霉素B脂质体治疗血液病患者侵袭性真菌感染2例并文献复习

胡耐博

摘 要 目的：探讨两性霉素B脂质体在血液病患者侵袭性真菌感染的应用时机、疗效及如何减少不良反应。方法：回顾我院2例应用两性霉素B脂质体成功治疗血液病晚期患者侵袭性真菌感染的治疗过程。结果：1例为老年白血病患者，化疗后粒细胞缺乏期应用三唑类药物预防真菌感染失败，出现真菌败血症，改用两性霉素B抢先治疗后获得痊愈；另1例为原发性骨髓纤维化晚期患者，长期粒细胞缺乏导致颅内侵袭性真菌感染，应用三唑类药物治疗无效，及时更换两性霉素B脂质体后取得良好疗效。结论：两性霉素脂质体B具有很好的组织渗透性，治疗侵袭性真菌感染患者能降低病死率，能透过血脑屏障有效治疗颅内侵袭性真菌感染；脂质体剂型能有效降低两性霉素B的毒副作用。

关键词 两性霉素B脂质体 侵袭性真菌感染 颅内感染 真菌败血症

中图分类号：R978.5； R519 文献标识码：C 文章编号：1006-1533（2014）15-0028-04

Liposomal amphotericin B in the treatment of invasive fungal infection in

patients with hematological diseases： two case reports and review of the literature

HU Naibo*

（Institute of Hematology and Blood Diseases Hospital，CAMS&PUMC，Tianjin 300020， China）

ABSTRACT Objective： To investigate the indications， efficacy and toxicity of liposomal amphotericin B in the treatment of invasive fungal infection in patients with hematological diseases. Methods： Two hematological patients with invasive fungal infection were successfully treated and their cases were retrospectively analyzed. Results： An elderly patient with leukemia failed to be treated with triazole antifungal agents as prophylaxis therapy after developed neutropenia following chemotherapy and he was diagnosed as fungal septicemia， then was treated with amphotericin B as a preemptive therapy and got a full recovery. Another patient with late stage primary myelofibrosis suffered from intracranial invasive fungal infection due to long term of neutropenia. He was treated with amphotericin B and obtained a good therapeutic effect after failed to be treated with triazole antifungal agents. Conclusion： Liposomal amphotericin B has a good tissue penetrative ability， can reduce mortality when applied in the treatment of patients with invasive fungal infection， and can pass through the blood-brain barrier resulting in effective treatment of intracranial fungal infection. Its liposome formulation can effectively reduce the adverse effects related to amphotericin B.

KEY WORDS liposomal amphotericin B； invasive fungal infection； intracranial infection； fungal septicemia

粒细胞缺乏的血液病患者容易合并侵袭性真菌感染，严重时可致真菌败血症或重要脏器感染。此类感染难于早期发现，一旦发生病情进展迅速，且抗真菌疗效差，病死率高。本文报道我院2例应用两性霉素B脂质体治疗侵袭性真菌感染的案例，并作文献复习，以提高对两性霉素B脂质体治疗侵袭性真菌感染的认识。

1 病例资料

1.1 病例1

男性64岁，因主诉“乏力、面色苍白1月”入院。入院前1月无明显诱因出现乏力，症状逐渐加重，无发热，无鼻衄及牙龈出血，无咳嗽、咳痰。……