目的 探究伏立康唑序貫治療慢性阻塞性肺疾病（COPD）急性加重期合并肺曲霉病的臨床效果。方法 2012年2月—2013年11月收治的COPD急性加重期合并肺曲霉病患者110例，隨機分為對照組（55例）和治療組（55例），對照組口服伊曲康唑膠囊，200 mg/次，2次/d，3 d后改為1次/d。治療組進行伏立康唑序貫治療，靜脈滴注注射用伏立康唑6 mg/（kg·次），2次/d，持續(xù)3 d后改為4 mg/（kg·次），2次/d，靜脈滴注共持續(xù)8 d，此后改為口服伏立康唑片，150 mg/次，2次/d，共持續(xù)6 d。兩組均持續(xù)治療14 d。治療后，對兩組的臨床療效進行評價，同時比較兩組治療前后腫瘤壞死因子-α（TNF-α），白細胞介素-8（IL-8），白細胞介素-10（IL-10），白細胞介素-19（IL-19）。結(jié)果 治療組和對照組的總有效率分別為83.63%、61.82%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.01）。治療后，治療組胸痛、咳嗽咳痰、咯血、紫紺、呼吸困難病例數(shù)明顯低于對照組，兩組比較差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組TNF-α、IL-8、IL-10、IL-19水平均較治療前顯著降低，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療后，治療組TNF-α、IL-8顯著低于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 伏立康唑序貫療法治療COPD急性加重期合并肺曲霉病有較好的臨床療效，可明顯改善患者的臨床癥狀、體征，可更好的調(diào)節(jié)患者的免疫功能，建議臨床推廣使用。

Objective To investigate the clinical efficacy of voriconazole sequential therapy in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary aspergillosis. Methods Patients (110 cases) with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary aspergillosis from February 2012 to November 2013 were randomly divided into control (55 cases) and treatment (55 cases) groups. The patients in the control group were po administered with Itraconazole Capsules, 200 mg/time, twice daily for 3 d, then once daily. The patients in the treatment group were accepted voriconazole sequential therapy, they were iv administered with Voriconazole for injection, 6 mg/(kg·time) from the first day, twice daily for 3 d, then 4 mg/(kg·time) twice daily, and iv drip for 8 d. Since then they were orally adminstered Voriconazole Tablets, 150 mg/time, twice daily for 6 d. The patients in the two groups were treated for 14 d. After the treatment, the treatment efficacy was evaluated, while TNF-α, IL-8, IL-10, and IL-19 were compared between the two groups. Results The efficacies in the treatment and control groups were 83.63% and 61.82%, respectively, and there were differences between the two groups (P < 0.01). After the treatment, cases of chest pain, cough and expectoration, hemoptysis, cyanosis, difficulty breathing in the treatment group were significantly lower than those in the control group, and there was significant difference between the two groups (P < 0.05). After the treatment, TNF-α, IL-8, IL-10 in the two groups were significantly reduced, and the difference was statistically significant before and after the treatment in the same group (P < 0.05). And reduced degree in the treatment group was greater than that in the control group, and there was significant difference between the two groups (P < 0.05). Conclusion Voriconazole sequential therapy has a good clinical effect in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary aspergillosis, can obviously improve the clinical symptoms and signs, while can better adjust the immune function of patients, which is worthy of clinical application.