卡泊芬净治疗急性红白血病伴临床诊断卡氏肺孢子虫肺炎一例并文献复习.pdfVIP

卡泊芬净治疗急性红白血病伴临床诊断卡氏肺孢子虫肺炎一例并文献复习 倪蓓文 黄洪辉 王婷 陈芳源* 上海交通大学医学院附属仁济医院血液科，上海，200127 摘要：肺孢子虫肺炎(PneumocystiscarniiPneumonia，PCP)是由卡氏肺孢子虫 （现称卡氏肺孢子菌或伊氏 肿孢子菌）所致的一种机会性感染，发生于免疫抑制或受损情况下。常见于人类免疫缺陷病毒(HIV)感 染者，而非HIV感染者 （如血液系统疾病、实体器官移植术后、结缔组织疾病、慢性阻塞性肺病患者等） 并发PCP的病例也越来越多。PCP临床表现缺乏特异性，疾病进展快，死亡率高，这给临床诊断及治疗带来 一些困难。PCP传统药物 （TMP-SMZ、氨苯砜、伯氨喹等）肝毒性及血液系统副作用较多，限制了这些药 物的临床使用，并且TMP-SMZ的耐药也不断上升。新型抗真菌药卡泊芬净(caspofungin)，毒性小，耐受 好，成为TMP-SMZ治疗PCP失败或不能耐受的选择。本文报道一例卡泊芬净治疗急性白血病患者伴发PCP 的病例。通过查阅文献，对9例卡泊芬净治疗成功病例进行汇总，以期提供一些相关临床经验。 关键词：卡泊芬净；急性红白血病；卡氏肺孢子虫肺炎 Efficacyofcaspofungintreatmentforseverepneumocystispneumoniainanacuteerythroid leukemiapatientandtheliteraturereview NIBei-wenHUNGHong-huiWANGTingCHENFang-yuan* DepartmentofHematology,ShanghaiRenjiHospital,ShanghaiJiaoTongUniversitySchoolofMedicine, Shanghai200127,China Abstract:PneumocystiscarniiPneumonia(PCP)isaseriousopportunisticinfectioncausedbypneumocystis carinii (currently pneumocystisjirovecii) that occurs almost exclusively in immunosuppressed or immunocompromisedpersons.ItisgenerallyrecognizedinAIDSpatients.However,withthecurrentlyrising numberofpatientsreceivingimmunosuppressivetherapiesformalignancies,allogeneicorgantransplantationsand autoimmunediseases,theincidenceofPCPhasincreasedinnon-HIVimmunosuppressedindividuals.Theclinical presentationofPCPisnon-specificwhereaswitharapidprogressandhighmortality,whichbringschallengesfor thediagnosisandmanagement.CommonlyusedagentsforPCPincludetrimethoprim-sulfamethoxazole (TMP-SMZ;cotrimoxazole),dapsoneandprimaquine.However,thehepatictoxicityandmyelosuppressionarethe mostimportantadverseeffectsthatlimittheclinicaluseoftheseagents.Moreover,thedrugresistanceto TMP-SMZisalsobecomingmoreandmorerecognized.Caspofungin,anovelantifungalagentwithexcellent tolerabilityandrelativelackoftoxicity,hasshownpotentialsasanalternativeagentforthema