糖皮质激素对泊沙康唑预防与治疗恶性血液病患者侵袭性真菌感染疗效的影响：一项回顾性研究

doi:10.12114/j.issn.1007-9572.2025.0052

中国全科医学 ›› 2026, Vol. 29 ›› Issue (32): 4798-4804.DOI: 10.12114/j.issn.1007-9572.2025.0052

糖皮质激素对泊沙康唑预防与治疗恶性血液病患者侵袭性真菌感染疗效的影响：一项回顾性研究

苑世朝¹^,², 刘琰¹^,², 刘帅¹^,², 赵岩¹^,², 王紫怡¹^,², 于静¹^,²^,^*()

1．050000　河北省石家庄市，河北医科大学第一医院临床药学部
2．050000　河北省石家庄市，河北省人工智能临床药学技术创新中心

收稿日期:2025-03-21 修回日期:2025-08-30 出版日期:2026-11-15 发布日期:2026-10-10
通讯作者: 于静
本文为中文翻译版本,原文"A retrospective study on the impact of glucocorticoids on the efficacy of posaconazole in the prevention/treatment of invasive fungal infections in patients with hematological malignancies",已获得授权。翻译与出版遵循COPE和ICMJE关于二次发表的指南。

作者贡献：
苑世朝和刘帅负责研究的构思，设计和实施，撰写论文；赵岩负责统计学处理；王紫怡负责数据的收集和整理；刘琰和于静负责论文的质量控制和审查，对文章整体负责。
基金资助:
2021年度河北省医学科学研究课题(20210368); 2024年政府资助临床医学优秀人才培养项目(ZF2024130)

A Retrospective Study on the Impact of Glucocorticoids on the Efficacy of Posaconazole in the Prevention/Treatment of Invasive Fungal Infections in Patients with Hematological Malignancies

YUAN Shizhao¹^,², LIU Yan¹^,², LIU Shuai¹^,², ZHAO Yan¹^,², WANG Ziyi¹^,², YU Jing¹^,²^,^*()

1. Department of Clinical Pharmacy, the First Hospital of Hebei Medical University, Shijiazhuang 050000, China
2. The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, Shijiazhuang 050000, China

Received:2025-03-21 Revised:2025-08-30 Published:2026-11-15 Online:2026-10-10
Contact: YU Jing

摘要/Abstract

摘要： 背景泊沙康唑（PCZ）被广泛应用于预防和治疗恶性血液病患者的侵袭性真菌感染，PCZ血浆药物谷浓度（PCZ Cmin）与临床疗效呈显著相关性。目的本研究旨在分析糖皮质激素（GCS）对PCZ Cmin及其预防与治疗侵袭性真菌感染临床结局的影响。方法采用回顾性研究设计，纳入2021年9月—2023年9月在河北医科大学第一医院血液科接受PCZ预防与治疗侵袭性真菌病的患者。根据是否合用GCS，将患者分为合用GCS组和未合用GCS组，并根据GCS给药天数将合用GCS组分为短期、中期和长期GCS亚组；将血浆样本分为GCS暴露组和非暴露组，并根据GCS给药剂量分为低剂量GCS亚组和中/高剂量GCS亚组，同时根据是否合用GCS或质子泵抵制剂（PPIs）将血浆样本分为PPIs暴露组、GCS暴露组、PPIs和GCS暴露组以及对照组，主要观察指标为PCZ Cmin及剂量校正浓度最低血浆药物浓度/剂量比值（Cmin/Dose，C/D），次要观察指标为各组间预防或治疗侵袭性真菌病（IFD）的临床结局。结果本研究共纳入IFD患者86例，血浆样本283例。主要结果如下：（1）合用GCS组的PCZ Cmin和C/D均低于未合用GCS组（Z=-2.146，P=0.032；Z=-2.070，P=0.038）；（2）低剂量GCS亚组的PCZ Cmin高于中/高剂量GCS亚组（Z=-3.841，P<0.001）；（3）短期GCS亚组和中期GCS亚组的PCZ Cmin均高于长期GCS亚组（Z=-2.677，P=0.007；Z=-2.408，P=0.016）；（4）PPIs暴露组，GCS暴露组以及PPIs和GCS暴露组的PCZ Cmin均低于对照组（Z=-3.593，P<0.001；Z=-3.375，P<0.001；Z=-3.427；P<0.001）。结论合用GCS可显著降低PCZ的血浆暴露水平，且降低程度呈剂量依赖性和时间依赖性。然而，合用GCS可能不会影响PCZ预防与治疗侵袭性真菌感染的临床结局。

关键词: 侵袭性真菌感染, 泊沙康唑, 糖皮质激素, 药物血浆浓度, 回顾性研究

Abstract:

Background

Posaconazole (PCZ) has been used to prevent and treat invasive fungal disease (IFD) in immunocompromised patients with hematological malignancies. There is a significant correlation between plasma minimum concentration (PCZ Cmin) and the efficacy.

Objective

This study aimed to investigate the effects of glucocorticoid (GCS) on PCZ Cmin and on the outcome of PCZ prevention/treatment of invasive fungal infections.

Methods

Using a retrospective study design, patients who received PCZ for the prevention and treatment of invasive fungal disease in the Department of Hematology of the First Hospital of Hebei Medical University from September 2021 to September 2023 were included. According to whether GCS was co-administered, patients were divided into a GCS co-administration group and a non-co-administration group; the GCS co-administration group was further divided into short-term, intermediate-term, and long-term GCS subgroups based on the duration of GCS administration. Plasma samples were divided into a GCS exposure group and a non-exposure group, and further into a low-dose GCS subgroup and a medium/high-dose GCS subgroup according to the GCS dose. In addition, according to whether GCS or PPIs were co-administered, plasma samples were divided into a PPI exposure group, a GCS exposure group, a PPI plus GCS exposure group, and a control group. The primary outcome measures were PCZ Cmin and the dose-adjusted concentration Cmin/Dose (C/D), and the secondary outcome measure was the clinical outcome of the prevention or treatment of invasive fungal disease (IFD) in each group.

Results

A total of 86 patients with IFD and 283 plasma samples were included in this study. The main results are as follows: (1) The concomitant usage of GCS reduced PCZ Cmin (Z=-2.146, P=0.032) and the Cmin/Dose (C/D) (Z=-2.070, P=0.038). (2) The low-dose GCS subgroup exhibited a significantly higher PCZ Cmin than the medium/high-dose GCS subgroup (Z=-3.841, P<0.001). (3) Both the short-term and medium-term GCS subgroups showed significantly higher PCZ Cmin levels compared to the long-term GCS subgroup (Z=-2.677, P=0.007; Z=-2.408, P=0.016). (4) Compared with PCZ alone, the concomitant usage of PPIs, glucocorticoids, and PPIs & glucocorticoids significantly reduced PCZ Cmin (Z=-3.593, P<0.001; Z=-3.375, P<0.001; Z=-3.427, P<0.001).

Conclusion

Concomitant use of glucocorticoids significantly reduces plasma exposure of posaconazole in a dose- and time-dependent manner. However, GCS co-administration may not affect the clinical outcomes of posaconazole in preventing or treating invasive fungal infections.

Key words: Invasive fungal infection, Posaconazol, Glucocorticoids, Plasma drug concentration, Retrospective study

中图分类号:

R 519.9

苑世朝,刘琰,刘帅,等. 糖皮质激素对泊沙康唑预防与治疗恶性血液病患者侵袭性真菌感染疗效的影响：一项回顾性研究[J]. 中国全科医学, 2026, 29(32): 4798-4804. DOI: 10.12114/j.issn.1007-9572.2025.0052.
YUAN Shizhao,LIU Yan,LIU Shuai, et al. A Retrospective Study on the Impact of Glucocorticoids on the Efficacy of Posaconazole in the Prevention/Treatment of Invasive Fungal Infections in Patients with Hematological Malignancies[J]. Chinese General Practice, 2026, 29(32): 4798-4804. DOI: 10.12114/j.issn.1007-9572.2025.0052.

图/表 4

参考文献 38

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项目	数值
年龄[M（P₂₅，P₇₅），岁]	54.4（40.0，68.0）
性别[例（%）]
男	49（57.00）
女	37（43.00）
BMI[M（P₂₅，P₇₅），kg/m²]	23.67（21.04，26.37）
药物谷浓度测量次数[M（P₂₅，P₇₅），次]	2.50（1.00，4.25）
PCZ日剂量[M（P₂₅，P₇₅），mg]	600.00（600.00，800.00）
PCZ用药天数[M（P₂₅，P₇₅），d]	14.00（8.00，21.00）
PCZ血浆药物谷浓度[M（P₂₅，P₇₅），μg/L]	1 160.12（590.75，2 000.00）
PCZ剂量矫正谷浓度[M（P₂₅，P₇₅），μg·L^-1·mg^-1]	1.73（0.88，3.20）
住院天数[M（P₂₅，P₇₅），d]	28.50（21.75，36.25）
潜在疾病[例（%）]
ALL	7（8.14）
MDS	10（11.63）
AML	48（55.81）
其他	21（24.42）
接受化学治疗[例（%）]	49（56.98）
ALB[M（P₂₅，P₇₅），g/L]	34.00（30.40，37.20）
AST[M（P₂₅，P₇₅），U/L]	19.25（15.20，30.92）
ALT[M（P₂₅，P₇₅），U/L]	20.20（11.77，36.62）
ALP[M（P₂₅，P₇₅），U/L]	75.00（58.00，107.50）
AST/ALT[M（P₂₅，P₇₅）]	1.05（0.70，1.44）
γ-GT[M（P₂₅，P₇₅），U/L]	26.50（19.00，61.25）
TBIL[M（P₂₅，P₇₅），μmol/L]	11.80（9.27，16.65）
SCr[M（P₂₅，P₇₅），μmol/L]	56.75（43.80，70.10）
BUN[M（P₂₅，P₇₅），mmol/L]	4.86（3.63，5.94）
CK[M（P₂₅，P₇₅），mmol/L]	33.00（20.00，64.00）
K[M（P₂₅，P₇₅），U/L]	3.67（3.37，3.92）

项目	数值
年龄[M（P₂₅，P₇₅），岁]	54.4（40.0，68.0）
性别[例（%）]
男	49（57.00）
女	37（43.00）
BMI[M（P₂₅，P₇₅），kg/m²]	23.67（21.04，26.37）
药物谷浓度测量次数[M（P₂₅，P₇₅），次]	2.50（1.00，4.25）
PCZ日剂量[M（P₂₅，P₇₅），mg]	600.00（600.00，800.00）
PCZ用药天数[M（P₂₅，P₇₅），d]	14.00（8.00，21.00）
PCZ血浆药物谷浓度[M（P₂₅，P₇₅），μg/L]	1 160.12（590.75，2 000.00）
PCZ剂量矫正谷浓度[M（P₂₅，P₇₅），μg·L^-1·mg^-1]	1.73（0.88，3.20）
住院天数[M（P₂₅，P₇₅），d]	28.50（21.75，36.25）
潜在疾病[例（%）]
ALL	7（8.14）
MDS	10（11.63）
AML	48（55.81）
其他	21（24.42）
接受化学治疗[例（%）]	49（56.98）
ALB[M（P₂₅，P₇₅），g/L]	34.00（30.40，37.20）
AST[M（P₂₅，P₇₅），U/L]	19.25（15.20，30.92）
ALT[M（P₂₅，P₇₅），U/L]	20.20（11.77，36.62）
ALP[M（P₂₅，P₇₅），U/L]	75.00（58.00，107.50）
AST/ALT[M（P₂₅，P₇₅）]	1.05（0.70，1.44）
γ-GT[M（P₂₅，P₇₅），U/L]	26.50（19.00，61.25）
TBIL[M（P₂₅，P₇₅），μmol/L]	11.80（9.27，16.65）
SCr[M（P₂₅，P₇₅），μmol/L]	56.75（43.80，70.10）
BUN[M（P₂₅，P₇₅），mmol/L]	4.86（3.63，5.94）
CK[M（P₂₅，P₇₅），mmol/L]	33.00（20.00，64.00）
K[M（P₂₅，P₇₅），U/L]	3.67（3.37，3.92）

项目	例数	预防情况		治疗情况		总计
项目	例数	成功	失败	成功	失败	成功	失败
合用GCS组	67	55（69.62）	5（6.33）	5（71.43）	2（28.57）	60（69.77）	7（8.14）
未合用GCS组	19	19（24.05）	0	0	0	19（22.09）	0
χ²值		1.690				2.161
P值		0.194				0.142

项目	例数	预防情况		治疗情况		总计
项目	例数	成功	失败	成功	失败	成功	失败
合用GCS组	67	55（69.62）	5（6.33）	5（71.43）	2（28.57）	60（69.77）	7（8.14）
未合用GCS组	19	19（24.05）	0	0	0	19（22.09）	0
χ²值		1.690				2.161
P值		0.194				0.142

糖皮质激素对泊沙康唑预防与治疗恶性血液病患者侵袭性真菌感染疗效的影响：一项回顾性研究

A Retrospective Study on the Impact of Glucocorticoids on the Efficacy of Posaconazole in the Prevention/Treatment of Invasive Fungal Infections in Patients with Hematological Malignancies

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