目的 探究伏立康唑序贯治疗慢性阻塞性肺疾病（COPD）急性加重期合并肺曲霉病的临床效果。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，随机分为对照组（55例）和治疗组（55例），对照组口服伊曲康唑胶囊，200 mg/次，2次/d，3 d后改为1次/d。治疗组进行伏立康唑序贯治疗，静脉滴注注射用伏立康唑6 mg/（kg·次），2次/d，持续3 d后改为4 mg/（kg·次），2次/d，静脉滴注共持续8 d，此后改为口服伏立康唑片，150 mg/次，2次/d，共持续6 d。两组均持续治疗14 d。治疗后，对两组的临床疗效进行评价，同时比较两组治疗前后肿瘤坏死因子-α（TNF-α），白细胞介素-8（IL-8），白细胞介素-10（IL-10），白细胞介素-19（IL-19）。结果 治疗组和对照组的总有效率分别为83.63%、61.82%，两组比较差异有统计学意义（P<0.01）。治疗后，治疗组胸痛、咳嗽咳痰、咯血、紫绀、呼吸困难病例数明显低于对照组，两组比较差异均有统计学意义（P<0.05）。治疗后，两组TNF-α、IL-8、IL-10、IL-19水平均较治疗前显著降低，同组治疗前后差异有统计学意义（P<0.05）；治疗后，治疗组TNF-α、IL-8显著低于对照组，两组比较差异有统计学意义（P<0.05）。结论 伏立康唑序贯疗法治疗COPD急性加重期合并肺曲霉病有较好的临床疗效，可明显改善患者的临床症状、体征，可更好的调节患者的免疫功能，建议临床推广使用。

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.