关键词: 肝衰竭, 肺部真菌感染, 伏立康唑, 治疗

Abstract: Objective To investigate the efficacy of voriconazole in the treatment of patients with liver failure complicated by pulmonary fungal infection（PFI）. Methods 26 patients with liver failure complicated by PFI were recruited in our hospital between February 2015 and August 2018,and 14 patients received voriconazole and 12 patients received itraconazole. All patients were followed-up for 12 weeks. Serum interleukin-6 （IL-6） and tumor necrosis factor-alpha（TNF-alpha） were detected by ELISA,and peripheral lymphocyte subsets were assayed by FC. Results At the end of 4 weeks,serum bilibubin level in patients receiving voriconazole was（96.2±54.3）μmol/L,much lower than[（178.3±89.4） μmol/L,P<0.05] in itraconazole-treated patients;serum IL-6 level was （11.5±6.7） pg/ml,significantly lower than[（18.5±6.8）pg/ml,P<0.05] in itraconazole-treated patients;the average time of fungal infection occurrence in all the patients was （27.21±15.96） d,while the onset of infection in patients with chronic-0n-acute liver failure was（17.8±6.9） d much earlier than[（37.2±16.4）d,P<0.05] in patients with chronic liver failure;there were no significant differences as respect to the changes of peripheral blood lymphocyte subsets and liver or renal function tests;no severe untoward reaction was found after the anti-fungal therapy;at the end of 12-week followed-up,6（42.9%） out of voriconazole-treated patients,while only 3 （25.0%,P<0.05） of itraconazole-treated patients survived. Conclusion The application of voriconazole could effectively control the pulmonary fungal infection in patients with liver failure,and prolong the survival,which might be related to the inhibition of general inflammatory reaction.

Key words: Liver failure, Pulmonary fungal infection, Vorionazole, Therapy