| ObjectiveTo evaluate the efficacy and safety of antifungal prophylaxis with voriconazole in hematological malignancies patients with invasive fungal disease(IFD).Based these datas,we aimed to investigate the efficacy,adverse reaction and health economics of voriconazole treatment prophylatically in combination with thymosin in hematological malignancies patients with IFD,which will provide a theoretical foundatio n for the clinical practice of antifungal prophylaxis of IFD in patients with hematological malignancies.Methods:A total of 97 patients with hematological malignancies who were selected from the hematology department of the first affiliated hospital of Ji Shou university from January 2013 to December 2019.Among these patients,29 patients received thymosin treatment in combina tion with voriconazole,26 patients received prophylatically voriconazole treatment alone,and 42 patients received without voriconazole or thymosin.The incidence,mortality in 30 or 100 daysl,cost of hospitalization as well as the adverse drug react of IFD in patients with or without voriconazole prophylaxis were analyzed during hospitalization.In addition,we discussed that the necessarity of thymosin and voriconazole antifungal prophylaxis in clinical practice.On account of the adverse reactions and health economics,we also expounded the necessity in clinical application of immune-enhancing agents and broad-spe ctrum antifungal drugs.Results:1.The results of the study compared between the prophylactic treatment group(the prophylactic group)and the non-prophylactic treatment group(the control group).(1)Incidence of IFD: The incidence of IFD was 4(15.4%),including 1(3.85%),0(0%)and 3(11.55%)patients for proven,probable,and possible infection in the prophylactic group.The proven case of yeast infection was indicated by sputum culture.The incidence of IFD was 16(38.1%),including 2(4.76%),2(4.76%)and 12(28.58%)patient s for proven,probable,and possible infection in the control group.Among the proven cases,1 was streptococcus infection by sputum culture and 1 was candida tropianainfection by blood culture.The prophyla ctic group was smaller than the control group,and the difference wasstatistically significant(p<0.05).(2)Length of stay :34.46±9.94 days in the prophylactic group and 31.05±6.91 days in the control group.The prophylactic group was larger than the control group,and the difference was no statistically significant(p>0.05).(3)The mortality of 30 days:2(7.7%)died in theprophylactic group and 7(16.6%)in the control group.The prophylactic group was smaller than the control group,and the difference was no statistically significant(p>0.05).(4)The mortality of 100 days:9(34.6%)died in theprophylactic group and 16(38.1%)in the control group.The difference in the the prophylactic group was smaller than that in the control group,and the difference was no statistical significance(p>0.05).(5)The cost of hospitalization: the average total hospitalization cost in the prophylactic group was ?72590.72,while that in the control group was ?57251.91.The difference in the theprophylactic group was greater than that in the control group.The difference was no statistical significance(p>0.05).(6)The adverse reactions: 1 patient stopped the voriconazole due to asymptomatic liver function impairment,and no other adverse reactions.2.The results of the study compared between the antifungal prophylaxis with Thymosin combined with voriconazole(the combination group)and theantifungal prophylaxis with voriconazole(the single group).(1)Incidence of IFD: The incidence of IFD was 0 in the combin ation group.The incidence of IFD were 4(15.4%)patients in the single group.The combination group was smaller than the single group,the difference was statistically significant(p<0.05).(2)Length of stay :29.21±9.14 days in the combination group and 34.46±9.94 days in the single group.The combination group was larger than the single group.The difference was statistically significant(p<0.05).(3)The mortality of 30 days:1(3.4%)died in combination group and 2(7.7%)in the single group.The combination group was smaller than the single group,and the difference was no statistically significant(p>0.05).(4)The mortality of 100 days:8(27.6%)died in combination group and 9(34.6%)in the single group.The difference in the combination group was smaller than that in the single group,and the difference was no statistical significance(p>0.05).(5)The cost of hospitalization: the average total hospitalization cost in the combination group was ?56315.30,while that in the single group was ?72590.72.The difference in the combination group was greater than that in the single group,and the difference was no statistical significance(p>0.05).(6)The adverse reactions: 1 patient stopped the voriconazole due to tetter in the combination group,and 1 patient stopped the voriconazole due to asymptomatic liver function impairment,and no other a dverse reactions.conclusion :IFD is one of the main causes of death during chemotherapy in patients with hematological malignancies.And antifungal prophylaxis therapy has been paid more and more attention by clinicians.Our study showed that without increasing the cost of hospitalization,the first-line antifungal prophylaxis of IFD by voriconazole has a better efficacy and a higher safety in patients with hematological malignancies;anti fungal prophylaxis with thymosin combined with voriconazole can improve the efficacy,without increasing adverse reactions,and have a good safety.It also can shorten the length of the stay and do not increase the cost of hospitalization. |
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