Zhang Y, Wang Y G, Zhang J C, Zhang Y T, Liang J X, Mu J S
Department of Critical Care Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2021 Feb 20;29(2):137-142. doi: 10.3760/cma.j.cn501113-20190813-00302.
To investigate the safety and efficacy of voriconazole in the patients with cirrhosis at Child-Pugh C stage complicated by invasive fungal infection(IFI). A retrospective collection of medical records of 76 patients with cirrhosis at Child-Pugh C stage complicated by IFI who were admitted to our hospital, from August 2014 to August 2017 was carried out. All the 76 patients who used voriconazole to treat IFI were divided into recommended dose group for hepatic insufficiency(56 cases) and routine dose group(20cases). The two groups were observed and compared in terms of the voriconazole's plasma concentrations, the outcomes of IFI and the rate of untoward reactions. The liver functional indicators were also compared between before and after treatment each group. We used Student's t test, Z test, chi-square test, or Fisher's exact test, as appropriate, for statistical analysis. Both groups had good performance and low frequencies of side effects in the treatment of IFI, but there were also significant differences in the plasma concentrations of voriconazole and the incidence of untoward reactions between the two groups( = 0.008 and = 0.022). There commended dose group for hepatic insufficiency had lower adverse effect rate. The levels of direct bilirubin, alanine aminotransferase and aspartate aminotransferase were significantly lower after treatment of IFI in the recommended dose group for hepatic insufficiency( < 0.05). In our research, it is relatively safe and effective to use voriconazole to treat IFI in the patients with cirrhosis at Child-Pugh C stage if according to the recommended dose regimen for cirrhosis at Child-Pugh A,B stage.
探讨伏立康唑治疗Child-Pugh C级肝硬化合并侵袭性真菌感染（IFI）患者的安全性和有效性。回顾性收集我院2014年8月至2017年8月收治的76例Child-Pugh C级肝硬化合并IFI患者的病历资料。将76例使用伏立康唑治疗IFI的患者分为肝功能不全推荐剂量组（56例）和常规剂量组（20例）。比较两组伏立康唑血药浓度、IFI治疗效果及不良反应发生率，并比较两组治疗前后肝功能指标。根据情况分别采用t检验、Z检验、χ²检验或Fisher确切概率法进行统计学分析。两组在IFI治疗中均表现良好，不良反应发生率低，但两组伏立康唑血药浓度及不良反应发生率差异有统计学意义（P = 0.008，P = 0.022）。肝功能不全推荐剂量组不良反应发生率较低。肝功能不全推荐剂量组IFI治疗后直接胆红素、谷丙转氨酶和谷草转氨酶水平显著降低（P < 0.05）。本研究表明，Child-Pugh C级肝硬化患者按照Child-Pugh A、B级肝硬化推荐剂量方案使用伏立康唑治疗IFI相对安全有效。
