免疫调节与伏立康唑疗法治疗过敏性支气管肺曲霉菌病的效果研究
Study on the Effect of Immune Regulation and Voriconazole Therapy in the Treatment of Allergic Bronchopulmonary Aspergillosis
DOI: 10.12677/acm.2025.15102942, PDF,    科研立项经费支持
作者: 杨汝存：山东省第一康复医院呼吸内科，山东 临沂
关键词: 肺曲霉菌；免疫调节；伏立康唑；Pulmonary Aspergillus； Immune Regulation； Voriconazole
摘要: 目的：探讨免疫调节与伏立康唑疗法治疗过敏性支气管肺曲霉菌病的效果研究。方法：选取2018年1月~2025年3月在某院就诊的过敏性支气管肺曲霉菌病患者86例，随机分组，即对照组、观察组，均43例。对照组使用伏立康唑治疗，观察组使用免疫调节治疗。统计对照组和观察组临床疗效、实验室指标、安全性分析。结果：对照组、观察组两组间基线均衡可比，2组临床疗效总有效率比较，观察组治疗总有效率为97.67%，高于对照组的83.72%，差异具有统计学意义(χ2 = 6.135, P < 0.05)，观察组病灶吸收总有效率为86.04%，高于对照组69.76%，差异具有统计学意义(χ2 = 6.253, P < 0.05)。观察组、对照组与同组治疗前比较，治疗后两组白细胞计数和嗜酸性粒细胞计数明显降低(P < 0.05)，但治疗后组间指标比较差异无统计学意义(P > 0.05)，2组不良反应比较，差异无统计学意义(P > 0.05)。结论：免疫疗法有效提高过敏性支气管肺曲霉菌病的治疗效果，减轻患者体内炎症反应，改善肺功能，有助于病灶吸收，促进病情的恢复。
Abstract: Objective: Exploring the efficacy of immune regulation and Voriconazole therapy in the treatment of allergic bronchopulmonary aspergillosis. Method: 86 patients with allergic bronchopulmonary aspergillosis who visited a hospital from January 2018 to March 2025 were randomly divided into a control group and an observation group, with 43 patients in each group. The control group was treated with Voriconazole, while the observation group was treated with immunomodulatory therapy. Statistical analysis of clinical efficacy, laboratory indicators, and safety between the control group and observation group. Result: The baseline balance between the control group and the observation group is comparable. The total effective rate of clinical efficacy between the two groups is compared. The total effective rate of treatment in the observation group is 97.67%, which is higher than the 83.72% in the control group, and the difference is statistically significant (χ2 = 6.135, P < 0.05). The total effective rate of lesion absorption in the observation group is 86.04%, which is higher than the 69.76% in the control group, and the difference is statistically significant (χ2 = 6.253, P < 0.05). Compared with the same group before treatment, the observation group and control group showed a significant decrease in white blood cell count and eosinophil count after treatment (P < 0.05), but there was no statistically significant difference in indicators between the two groups after treatment (P > 0.05). There was no statistically significant difference in adverse reactions between the two groups (P > 0.05). Conclusion: Immunotherapy effectively improves the treatment effect of allergic bronchopulmonary aspergillosis, reduces the inflammatory response in patients, improves lung function, facilitates lesion absorption, and promotes disease recovery.
文章引用：杨汝存. 免疫调节与伏立康唑疗法治疗过敏性支气管肺曲霉菌病的效果研究[J]. 临床医学进展, 2025, 15(10): 1748-1755. https://doi.org/10.12677/acm.2025.15102942

参考文献

[1] Messer, S.A., Jones, R.N. and Fritsche, T.R. (2006) International Surveillance of Candida spp. and Aspergillus spp.: Report from the Sentry Antimicrobial Surveillance Program (2003). Journal of Clinical Microbiology, 44, 1782-1787. [Google Scholar] [CrossRef] [PubMed]
[2] Denning, D.W., Cadranel, J., Beigelman-Aubry, C., Ader, F., Chakrabarti, A., Blot, S., et al. (2016) Chronic Pulmonary Aspergillosis: Rationale and Clinical Guidelines for Diagnosis and Management. European Respiratory Journal, 47, 45-68. [Google Scholar] [CrossRef] [PubMed]
[3] Cadena, J., Thompson, G.R. and Patterson, T.F. (2021) Aspergillosis: Epidemiology, Diagnosis, and Treatment. Infectious Disease Clinics of North America, 35, 415-434. [Google Scholar] [CrossRef] [PubMed]
[4] Brown, G.D., Denning, D.W., Gow, N.A.R., Levitz, S.M., Netea, M.G. and White, T.C. (2012) Hidden Killers: Human Fungal Infections. Science Translational Medicine, 4, 165rv13. [Google Scholar] [CrossRef] [PubMed]
[5] Azoulay, E., Russell, L., Van de Louw, A., Metaxa, V., Bauer, P., Povoa, P., et al. (2020) Diagnosis of Severe Respiratory Infections in Immunocompromised Patients. Intensive Care Medicine, 46, 298-314. [Google Scholar] [CrossRef] [PubMed]
[6] Wiederhold, N.P. and Verweij, P.E. (2020) Aspergillus Fumigatus and Pan-Azole Resistance: Who Should Be Concerned? Current Opinion in Infectious Diseases, 33, 290-297. [Google Scholar] [CrossRef] [PubMed]
[7] Feys, S., Gonçalves, S.M., Khan, M., Choi, S., Boeckx, B., Chatelain, D., et al. (2022) Lung Epithelial and Myeloid Innate Immunity in Influenza-Associated or Covid-19-Associated Pulmonary Aspergillosis: An Observational Study. The Lancet Respiratory Medicine, 10, 1147-1159. [Google Scholar] [CrossRef] [PubMed]
[8] Lamoth, F. and Calandra, T. (2022) Pulmonary Aspergillosis: Diagnosis and Treatment. European Respiratory Review, 31, Article 220114. [Google Scholar] [CrossRef] [PubMed]
[9] Hagiya, H., Nishimura, Y. and Otsuka, F. (2023) Safety and Usefulness of Nebulized Liposomal Amphotericin B: Systematic Scoping Review. Pulmonary Pharmacology & Therapeutics, 82, Article 102233. [Google Scholar] [CrossRef] [PubMed]
[10] Patterson, T.F., Thompson, G.R., Denning, D.W., Fishman, J.A., Hadley, S., Herbrecht, R., et al. (2016) Executive Summary: Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 63, 433-442. [Google Scholar] [CrossRef] [PubMed]
[11] 吴亚, 李文利, 祝杨. 不同剂量激素联合伏立康唑治疗过敏性支气管肺曲霉病的临床疗效[J]. 实用药物与临床, 2022, 25(4): 313-316.
[12] Kosmidis, C. and Denning, D.W. (2015) The Clinical Spectrum of Pulmonary Aspergillosis. Thorax, 70, 270-277. [Google Scholar] [CrossRef] [PubMed]
[13] 李珊珊. 慢性阻塞性肺疾病合并侵袭性肺曲霉病临床特征分析及危险因素探究[D]: [硕士学位论文]. 南昌: 南昌大学, 2023.
[14] Barac, A., Kosmidis, C., Alastruey-Izquierdo, A. and Salzer, H.J.F. (2019) Chronic Pulmonary Aspergillosis Update: A Year in Review. Medical Mycology, 57, S104-S109. [Google Scholar] [CrossRef] [PubMed]
[15] Moazam, S., Eades, C.P., Muldoon, E.G., Moore, C.B., Richardson, M.D. and Rautemaa-Richardson, R. (2020) Positive aspergillus PCR as a Marker of Azole Resistance or Sub-Therapeutic Antifungal Therapy in Patients with Chronic Pulmonary Aspergillosis. Mycoses, 63, 376-381. [Google Scholar] [CrossRef] [PubMed]
[16] 钟芝梅. 伏立康唑联合两性霉素b治疗肺曲霉菌病的疗效及对炎症因子的影响[J]. 医师在线, 2024, 14(10): 48-50.
[17] 陈炆颖. 伏立康唑治疗COPD伴肺曲霉菌病的效果及对炎性因子的影响[J]. 北方药学, 2021, 18(1): 159-160.
[18] Oltolini, C., Ripa, M., Andolina, A., Brioschi, E., Cilla, M., Petrella, G., et al. (2019) Invasive Pulmonary Aspergillosis Complicated by Carbapenem-Resistant Pseudomonas Aeruginosa Infection during Pembrolizumab Immunotherapy for Metastatic Lung Adenocarcinoma: Case Report and Review of the Literature. Mycopathologia, 184, 181-185. [Google Scholar] [CrossRef] [PubMed]
[19] Gonçalves, S.M., Pereira, I., Feys, S., Cunha, C., Chamilos, G., Hoenigl, M., et al. (2024) Integrating Genetic and Immune Factors to Uncover Pathogenetic Mechanisms of Viral-Associated Pulmonary Aspergillosis. mBio, 15, e0198223. [Google Scholar] [CrossRef] [PubMed]

为你推荐