昆明地区三种马拉色菌皮肤病流行病学调查及山苍子油和抗真菌药物联合的体外药敏试验

发布时间：2018-03-02 09:39

  本文关键词： 马拉色菌 流行病学 山苍子油 抗真菌药物 体外联合药敏试验　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的1、了解昆明地区三种马拉色菌皮肤病即花斑癣、马拉色菌毛囊炎、脂溢性皮炎菌种分布情况和易感因素,为预防马拉色菌感染及减少发病率提供依据；2、研究山苍子油抗马拉色菌的活性及分别与氟康唑、伊曲康唑及酮康唑联合抗真菌效力,为临床治疗马拉色菌引起的相关疾病选择新型高效低毒的治疗药物和治疗方案提供理论依据。 方法1.收集临床典型、真菌镜检阳性的花斑癣、马拉色菌毛囊炎、脂溢性皮炎(头皮屑)的病例,并进行马拉色菌培养和鉴定,分析马拉色菌菌种构成情况,同时用自制调查表对入选病例进行易感因素调查。2.参照美国国家临床试验标准化委员会(NCCLS)提出的M27-A方案,测定山苍子油对临床分离优势菌株的最小抑菌浓度(MIC值)。3.同时测定了山苍子油与酮康唑、伊曲康唑、氟康唑分别联合抗马拉色菌的MIC值,对三种抗真菌药物与山苍子油联合用药前后的MIC值进行统计学分析比较。 结果1.共收集158例病例,男104例,女54例,平均年龄29.4岁,多汗、油性皮肤患者所占比例均超过60%,培养到111株马拉色菌,分离出6个菌种：糠秕马拉色菌38株、合轴马拉色菌29株、厚皮马拉色菌20株、限制马拉色菌11株、斯洛菲马拉色菌7株、钝形马拉色菌6株,优势菌株87株。2.山苍子油对临床分离的87株马拉色菌的优势菌株(糠秕、合轴、厚皮)MIC值范围为625～20000μg/ml,MIC均值为3130.76±846.752μg/ml,合轴马拉色菌、厚皮马拉色菌、糠秕马拉色菌的MIC平均值存在差异,糠秕马拉色菌的MIC平均值明显低于合轴及厚皮马拉色菌,差异有统计学意义(p0.05)；3.三种唑类抗真菌药对马拉色菌临床分离株的MIC值范围、MIC50和MIC90值有一定差别,三种唑类抗真菌药对马拉色菌敏感性由高到低分别为：伊曲康唑、酮康唑、氟康唑；4.山苍子油分别与酮康唑、伊曲康唑、氟康唑联合用药时各药物的MIC均值均比单用时有显著降低,具有统计学差异(P0.01)；0.5FICI≤1,联合应用有相加作用。 结论1.马拉色菌感染好发于男性青壮年,油性皮肤及多汗的患者更易发生花斑癣及马拉色菌毛囊炎,糠秕、合轴、厚皮马拉色菌为本地区马拉色菌感染的优势菌种,各疾病的优势菌种及菌种分布间存在差异；2.山苍子油对马拉色菌有抗真菌作用；3.3种唑类抗真菌药对不同马拉色菌菌种的敏感性有所不同；4.山苍子油与氟康唑、伊曲康唑、酮康唑有联合抗真菌作用。
[Abstract]:Objective 1. To understand the distribution and susceptible factors of three dermatosis species of Dermatophytes malassezia, I. E. tinea versicolor, Marassezia folliculitis and seborrheic dermatitis in Kunming area. In order to prevent Malassezia infection and reduce the incidence of Malassezia, the activity of litsea cubeba oil against Malassezia and its antifungal efficacy with fluconazole, itraconazole and ketoconazole were studied. To provide theoretical basis for the clinical treatment of malassezia related diseases and the selection of new high efficiency and low toxicity drugs and treatment schemes. Methods 1. The clinical typical, fungal positive cases of tinea versicolor, Marassezia folliculitis, seborrheic dermatitis (dandruff) were collected, and the culture and identification of Malassezia were carried out, and the composition of Malassezia was analyzed. 2. At the same time, a self-made questionnaire was used to investigate the predisposing factors of selected cases. (2) according to the M27-A scheme proposed by the National Committee for Standardization of Clinical Trials (NCCLS), The minimal inhibitory concentration (MIC) of litsea cubeba oil against clinically isolated dominant strains was determined. The MIC values of litsea cubeba oil, ketoconazole, itraconazole and fluconazole in combination with Malassezia were also determined. The MIC values of three antifungal drugs combined with litsea cubeba oil were analyzed and compared statistically. Results 1. 158 cases (104 males and 54 females) were collected. The average age was 29.4 years old. The proportion of patients with hyperhidrosis and oily skin was more than 600.111 strains of Malassezia were cultured and 6 strains were isolated: 38 strains of Malassezia furfur. There were 29 strains of Malassezia, 20 strains of Malassezia pachyderma, 11 strains of Malassezia, 7 strains of Slomarassezia, 6 strains of Malassezia obtuse. 87 strains of dominant strain 路2.The MIC value of litsea cubeba oil against clinical isolates of 87 Malassezia strains (chaff, meridian, rhipoderma, Malassezia, Malassezia, Malassezia, Malassezia furfurum, Malassezia, Malassezia, Malassezia furfurum, Malassezia, Malassezia, Malassezia, Malassezia, Malassezia, Malassezia, Malassezia, Malassezia, Mal@@. The average value of MIC of Malassezia furfurum was significantly lower than that of Malassezia chamazae and Malassezia thuringiensis, and the difference was statistically significant (p 0.05). There were some differences between the MIC values and MIC90 values of the three kinds of antifungal agents on Malassezia clinical isolates. The sensitivity of three kinds of antifungal agents to Malassezia from high to low are itraconazole, ketoconazole, fluconazole 4. litsea cubeba oil and ketoconazole, itraconazole, itraconazole, etc. The mean value of MIC of fluconazole combined with fluconazole was significantly lower than that of single drug, with statistical difference of 0.5 FICI 鈮，

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