课件：浅谈肺部曲霉菌感染的诊治ppt.pptVIP

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 防治原则 1.一般预防 2.靶向预防(预防性治疗) 3.拟诊治疗(经验性治疗) 4.临床诊断治疗(先发/抢先治疗) 5.确诊治疗(靶向治疗) 2019 - 抗真菌治疗的药物种类 细胞膜功能 多烯类 两性霉素B 细胞壁合成 棘白菌素类 卡泊芬净 麦角固醇合成 唑类 氟康唑 伊曲康唑 伏立康唑 核酸合成 5-氟胞嘧啶 2019 - Present by David Denning ECCMID 10th May 2015 in Barcelona 患者人群 Population 目的 Intention 干预手段 Intervention SoR QoE 文献 Reference 备注 Comment 慢性肺曲霉病进展期患者 CPA patients with progressive disease 控制感染性疾病进展 Control of infection 伊曲康唑起始200mg BID，通过血药浓度检测调整剂量 Itraconazole Start 200mg BID, adjust with TDM A II 无治疗药物对照研究数据 慢性肺曲霉病-三唑类药物治疗 Oral triazole therapy for CPA Population 伏立康唑起始150-250mg BID，通过血药浓度检测调整剂量 Voriconazole Start 150-250mg BID, adjust with TDM A II 泊沙康唑起始400mg BID Posaconazole Start 400mg BID B II 伏立康唑更适合用于半侵袭性曲霉病（SIA）/慢性坏死性肺曲霉病（CNPA）以及伴有真菌球的患者以减少耐药的风险 Agarwal, 2013; De Buele, 1998, Dupont, 1990; Campbell, 1991; Tsubura, 1997; Denning, 2003; Nam, 2009; Al-shair, 2013 Saito, 2009; Cadranel, 2012, Jain, 2006; Sambatakou, 2006; Camuset, 2007; Philippe, 2009; Al-shair, 2013 Felton, 2010; 应用伏立康唑，伊曲康唑时或权衡利弊使用泊沙康唑时需要血药浓度检测 目标浓度来自于侵袭性曲霉病，PK/PD和预防研究数据 2019 - Present by David Denning ECCMID 10th May 2015 in Barcelona 患者人群 Population 目的 Intention 干预手段 Intervention SoR QoE 文献 Reference 备注 Comment 慢性肺曲霉病进展期患者（初始治疗失败，三唑类药物不耐受，或三唑类药物耐药） CPA patients with progressive disease, who fail, are intolerant of triazoles or have triazole resistance 控制感染性疾病进展 Control of infection 米卡芬净 150mg/d Itraconazole Start 200mg BID, adjust with TDM B II 慢性肺曲霉病-针剂替代治疗 Alternative intravenous therapy for CPA 两性霉素B 0.7-1.0 mg/kg/d Amphotericin B deoxycholate 0.7-1.0mg/kg/d C III 卡泊芬净50-70 mg/d Caspofungin 50-70mg/d C IIa Kohno, 2011; Kohno, EJCMID 2013; Saito, 2009; Kohno, 2011; Kohno , 2004; Izumikawa, 2007; Yasuda, 2009; Nam, 2009 Denning, 2003 Kier, 2014; Kohno ECCMID 2013 两性霉素B脂质体 3mg/kg/d Liposomal AmB 3mg/kg/d B IIa Newton, 2