Leather Helen L, Wingard John R
Shands Healthcare at the University of Florida, 32610-0316, USA.
Curr Opin Infect Dis. 2006 Aug;19(4):371-9. doi: 10.1097/01.qco.0000235165.08797.81.
The use of combination antifungal therapy in hematopoietic stem-cell transplantation patients is controversial and limited by a paucity of controlled data. The recent literature is reviewed and the relative arguments for and against combination antifungal therapy are outlined with summative recommendations to assist practitioners in decision-making.
There is an abundance of in-vitro and murine in-vivo combination antifungal literature, whereas clinical data are less abundant and controlled. Of the published case series there is a suggested benefit to combination therapy over monotherapy, although there are limitations to the available literature. Other issues in the combination debate that are addressed include the following: improved response rates and a survival advantage have been demonstrated in recent monotherapy studies; response rates in most published combination therapy studies do not suggest large gains over monotherapy; the lack of sustained survival advantage to combination therapy studies; and finally the consideration of host defenses in treatment responses.
Based on available data, combination therapy is not warranted at the initial diagnosis of invasive aspergillosis. Randomized, controlled trials with rigorous study design are needed.
在造血干细胞移植患者中使用联合抗真菌治疗存在争议，且因缺乏对照数据而受到限制。本文对近期文献进行综述，并概述支持和反对联合抗真菌治疗的相关论点，同时给出总结性建议，以帮助从业者进行决策。
体外和小鼠体内联合抗真菌的文献很多，而临床数据较少且缺乏对照。在已发表的病例系列中，联合治疗似乎比单一治疗更具优势，尽管现有文献存在局限性。联合治疗争议中涉及的其他问题包括：近期的单一治疗研究已证明缓解率提高和生存优势；大多数已发表的联合治疗研究中的缓解率并未显示出比单一治疗有大幅提高；联合治疗研究缺乏持续的生存优势；最后是在治疗反应中对宿主防御的考虑。
基于现有数据，侵袭性曲霉病初诊时无需进行联合治疗。需要设计严谨的随机对照试验。
