To observe the clinical efficacy and safety of posaconazole injection and voriconazole injection in the treatment of patients with pulmonary tuberculosis complicated with invasive pulmonary aspergillosis (IPA).

Patients with pulmonary tuberculosis complicated with IPA were divided into control group and treatment group according to the treatment methods. Both groups maintained standardized anti-tuberculosis treatment. At the same time, the control group was given voriconazole for injection at a dose of 6 mg·kg^-1 ivgtt, q12 h on the first day; from the second day, 4 mg·kg^-1 ivgtt, q12 h. When the patient’s clinical condition was stable, switched to oral voriconazole tablets, 200 mg per dose, q12 h. Treatmen group was also given posaconazole injection, initially intravenously, with a dose of 300 mg ivgtt, q12 h on the first day; from the second day, 300 mg ivgtt, qd; when the patient’s clinical condition was stable, oral posaconazole oral suspension were switched to, 400 mg each time, bid. Both groups were treated for 12 weeks. The clinical efficacy, clinical symptom relief, galactomannan (GM) and 1-3-β-D glucan (BG) levels, lung function parameters, immune and inflammatory indicators were compared between the two groups of patients, and safety evaluation was carried out.

A total of 84 patients were enrolled, with 43 cases in control group and 41 cases in treatment group. The clinical effective rates in control group and treatment group were 79.07% (34 cases/43 cases) and 87.80% (36 cases/41 cases), respectively, with no statistically significant difference (P>0.05). The fever subsided time in control group and treatment group were (7.53±1.39) and (8.37±1.65) d, respectively; the recovery time of respiratory function were (5.26±1.66) and (4.44±1.70) months, respectively; the GM levels were (0.44±0.13) and (0.36±0.11) ng·mL^-1, respectively; BG levels were (25.62±5.86) and (22.77±5.34) pg·mL^-1, respectively; the arterial oxygen saturation (SaO₂) levels were (95.63±1.70)% and (96.56±1.70)%, respectively; the pulmonary dynamic compliance (Cdyn) levels were (32.25±4.65) and (34.72±4.49) mL·cm H₂O^-1, respectively; the levels of response frequency (Fres) were (11.39±1.78) and (10.46±1.75) Hz, respectively; the levels of maximum ventilation (MVV) were (78.12±8.87) and (83.68±8.19) L·min^-1, respectively; the carbon monoxide diffusing capacity (DLCO) levels were (62.93±4.37)% and (65.44±4.11)%, respectively; the levels of interleukin 5 (IL-5) were (1.31±0.38) and (1.11±0.32) ng·L^-1, respectively; the levels of interleukin 17 (IL-17) were (14.54±2.83) and (13.22±2.57) ng·L^-1, respectively; the levels of dendritic cell-associated C-type lectin-1 (Dectin-1) were (11.86±2.25) and (10.58±2.13) ng·L^-1, respectively; the immunoglobulinM (IgM) levels were (1.13±0.33) and (1.33±0.26) g·L^-1, respectively; the immunoglobulin E (IgE) levels were (1.09±0.27) and (0.90±0.25) g·L^-1, respectively. There were statistically significant differences in the above indexes between treatment group and control group (P<0.05, P<0.01). Regarding adverse drug reactions, control group primarily experienced nausea, elevated alanine aminotransferase, increased alkaline phosphatase and hallucinations, whereas the treatment group mainly reported nausea, vomiting, elevated alanine aminotransferase, elevated aspartate aminotransferase and hypokalemia. The total incidence of adverse drug reactions was 13.95% (6 cases/43 cases) in control group and 14.63% (6 cases/41 cases) in treatment group, with no statistically significant difference between two groups (P>0.05).

Both posaconazole injection and voriconazole injection can achieve good clinical responses in the treatment of patients with pulmonary tuberculosis complicated by IPA. Posaconazole has advantages in reducing fungal burden, improving lung function, and regulating immune inflammation. The safety of the two groups is equivalent. Posaconazole may have a slower onset of action, manifested by a longer time to resolve fever, but the long-term benefit in lung function is more significant.