Lamy T, Bernard M, Courtois A, Jacquelinet C, Chevrier S, Dauriac C, Grulois I, Guiguen C, Le Prise P Y
Service d'Hématologie clinique, Hopital Pontchaillou, Rennes, France.
Leuk Lymphoma. 1998 Jun;30(1-2):163-74. doi: 10.3109/10428199809050939.
Invasive pulmonary aspergillosis (IPA) is an increasing cause of morbidity and mortality in patients with hematologic malignancies. A major program of construction work close to our unit prompted us to evaluate the efficacy of itraconazole prophylaxis in preventing IPA in these patients. During September 1994 to December 1995, 77 patients undergoing 96 neutropenic episodes (mean duration, 19.3 days +/- 9.1) received itraconazole as antifungal prophylaxis. All patients were treated in laminar air flow rooms. Itraconazole was administered at a loading dose of 600mg/d, (day 1 to day 3) and 400mg/d on the following days, in 87 instances. In the remaining episodes, the daily dose was 200 or 400mg. Oral doses were adjusted to reach a plasma itraconazole level (PIL) above 1000ng/l. In cases of inadequate PIL or poor oral intake, IV AmphoB was started at a 20 mg daily dose. Five cases of IPA (proven n = 2, probable n = 3) were observed. This represents an incidence of 5.2% of the total number of episodes. One out of 67 (2%) treatment episodes with adequate PIL were associated with IPA as compared to 4 of 29 (14%) episodes with inadequate PIL, (p < 0.02). AmphoB was added in 28 cases because of low PIL (n = 25), and/or antibiotic-resistant fever persistent pulmonary infiltrate (n = 8). These results need to be interpreted with caution, because of the absence of randomization or a control group. The efficacy of Itraconazole in neutropenic patients with high risk IPA has to be confirmed on larger and prospective studies.
侵袭性肺曲霉病（IPA）在血液系统恶性肿瘤患者中导致发病和死亡的情况日益增多。我们单位附近的一项大型建设工程促使我们评估伊曲康唑预防此类患者发生IPA的疗效。在1994年9月至1995年12月期间，77例经历96次中性粒细胞减少发作（平均持续时间为19.3天±9.1天）的患者接受了伊曲康唑作为抗真菌预防用药。所有患者均在层流室接受治疗。87例患者中，伊曲康唑的负荷剂量为600mg/d（第1天至第3天），随后每天400mg。在其余发作中，每日剂量为200mg或400mg。调整口服剂量以使血浆伊曲康唑水平（PIL）高于1000ng/l。在PIL不足或口服摄入不佳的情况下，开始静脉注射两性霉素B，每日剂量为20mg。观察到5例IPA（确诊2例，可能3例）。这占发作总数的5.2%。PIL充足的67例治疗发作中有1例（2%）与IPA相关，而PIL不足的29例发作中有4例（14%）与之相关，（p<0.02）。由于PIL低（25例）和/或抗生素耐药性发热伴持续肺部浸润（8例），28例患者加用了两性霉素B。由于缺乏随机分组或对照组，这些结果需要谨慎解读。伊曲康唑在高危IPA中性粒细胞减少患者中的疗效必须通过更大规模的前瞻性研究来证实。
