Izumikawa Koichi, Ohtsu Yoshiko, Kawabata Masateru, Takaya Hisashi, Miyamoto Atsushi, Sakamoto Susumu, Kishi Kazuma, Tsuboi Eiyasu, Homma Sakae, Yoshimura Kunihiko
Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
Med Mycol. 2007 May;45(3):273-8. doi: 10.1080/13693780701278386.
The rising incidence of pulmonary aspergillosis is a major clinical concern. However, only a limited number of antifungal drugs are available in Japan that are effective for pulmonary Aspergillus infections. Micafungin (MCFG), a newly developed echinocandin family antifungal drug, has potent antifungal activity in vitro, but few reports detailing its clinical effectiveness have been published to date. A retrospective study was performed using data from nine patients (seven males and two females) with chronic invasive forms of pulmonary aspergillosis, who were treated with either MCFG alone or together with other antifungal drugs between April 2003 and March 2004. The overall efficacy of the treatments was evaluated in the terms of clinical, mycological, serological and radiological responses. The average age of the patients was 61.9 (20-83) years old. Four patients received only MCFG and the remaining five patients were treated with MCFG in combination with amphotericin B (AMB) only (1 patient), itraconazole (ITC) only (2 patients) or AMB backed up by ITC during AMB discontinuation periods (2 patients). The mean duration of MCFG administration was 59.2 (28-96) days. Overall, the treatment was judged to have been effective for seven of nine patients. No patient's condition deteriorated in response to treatment. Administration of MCFG alone was judged to have been effective in three of four patients. No notable adverse effects were documented during MCFG administration. These data suggest that MCFG may be an effective and safe antifungal drug for the treatment of chronic invasive forms of pulmonary aspergillosis.
肺曲霉病发病率的上升是一个主要的临床问题。然而，在日本，对肺部曲霉感染有效的抗真菌药物数量有限。米卡芬净（MCFG）是一种新开发的棘白菌素类抗真菌药物，在体外具有强大的抗真菌活性，但迄今为止，很少有详细报道其临床疗效的研究发表。我们进行了一项回顾性研究，使用了2003年4月至2004年3月期间9例慢性侵袭性肺曲霉病患者（7例男性和2例女性）的数据，这些患者单独使用MCFG或与其他抗真菌药物联合治疗。从临床、真菌学、血清学和影像学反应方面评估了治疗的总体疗效。患者的平均年龄为61.9（20 - 83）岁。4例患者仅接受MCFG治疗，其余5例患者分别与两性霉素B（AMB）（1例）、伊曲康唑（ITC）（2例）联合使用MCFG，或在AMB停药期间接受ITC辅助的AMB治疗（2例）。MCFG的平均给药时间为59.2（28 - 96）天。总体而言，9例患者中有7例的治疗被判定为有效。没有患者因治疗而病情恶化。单独使用MCFG治疗的4例患者中有3例被判定为有效。在MCFG给药期间未记录到明显的不良反应。这些数据表明，MCFG可能是治疗慢性侵袭性肺曲霉病的一种有效且安全的抗真菌药物。
