卡泊芬净与阿司匹林、维拉帕米联合应用对白念珠菌体外抗菌效果的研究

发布时间：2018-06-17 12:59

本文选题：白念珠菌 + 卡泊芬净　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:1、初步了解本地区女性患者感染VVC的情况并对其致病菌的菌种的类型及分布进行分析;2、初步探究VVC患者中白念珠菌对常见唑类药物和卡泊芬净的敏感性;3、探究卡泊芬净联合阿司匹林、维拉帕米作用于游离态白念珠菌是否产生增敏现象。方法:将2016年3月至2016年10月期间,就诊于山西省妇幼保健院门诊疑似VVC患者纳为研究对象,收起真菌镜检为阳性的分泌物标本共103株,对其进行连续真菌培养、传代后,分别采用科玛嘉显色培养基、API 20C AUX及分子生物学方法对获得的念珠菌属进行菌种鉴定,最终得到了白念珠菌79株。采用M27-A3微量液基稀释法,将抗真菌药物单药应用对其中42株白念珠菌进行体外药敏实验,分别将白念珠菌对四种抗真菌药物的MIC50值进行记录,计算并比较白念珠菌对四种抗真菌药物的耐药率;将卡泊芬净与阿司匹林、维拉帕米联合应用对42株白念珠菌进行体外药敏实验,观察卡泊芬净单独用药和联合用药后卡泊芬净的MIC50值,分析其MIC50值的改变与联合用药的关系,进一步探究卡泊芬净联合阿司匹林、维拉帕米分别作用于游离状态下的白念珠菌时是否会产生增敏现象。结果:1、本实验共收集疑似VVC患者的分泌物标本103例,最终获得实验所需临床菌株101株,其中白念珠菌占79株(78.22%),光滑念珠菌占12株(11.88%),热带念珠菌占4株(3.96%),近平滑念珠菌占3株(2.97%),克柔念珠菌占1株(0.99%),其它菌占2株(1.98%)。2、卡泊芬净及常见唑类药物对42株白念珠菌体外药敏试验结果为:有20株菌对氟康唑产生耐药现象,耐药率约为47.6%;有24株菌对伊曲康唑产生耐药,耐药率约为57.1%;有18株菌对伏立康唑产生耐药,耐药率约为42.8%;有13株菌对卡泊芬净产生耐药,耐药率约为30.9%。3、卡泊芬净与阿司匹林、维拉帕米联合应用于游离态白念珠菌后,卡泊芬净的MIC50值均由0.0156-8μg/m L降至0.0156-4μg/m L。联合用药前后MIC50值统计学分析显示:卡泊芬净与阿司匹林、维拉帕米联合用药前后卡泊芬净的MIC50值,经正态性检验,数据均符合正态分布,采用t检验,结果用均数±标准差(sx±)表示。(1)卡泊芬净单独用药组(2.47±2.97)高于卡泊芬净与阿司匹林联合用药组(0.75±1.08),t=3.536,P=0.01,差异具有统计学意义。(2)卡泊芬净单独用药组(2.47±2.97)高于卡泊芬净与维拉帕米联合用药组(0.68±1.09),t=3.677,P=0.01,差异具有统计学意义。结论:1、念珠菌属是是VVC患者的主要病原菌,白念珠菌仍占主要比例,白念珠菌对卡泊芬净的敏感性高于常见唑类药物。2、白念珠菌对卡泊芬净的耐药率低于氟康唑、伏立康唑、伊曲康唑。3、阿司匹林、维拉帕米与卡泊芬净联用均可以增加卡泊芬净对游离态白念珠菌的敏感性,两种药物均可以做为卡泊芬净的增敏剂,为VVC治疗提供新策略。
[Abstract]:Objective to explore the sensitivity of Candida albicans to common azole drugs and carpofensin in VVC patients, and to analyze the type and distribution of VVC bacteria in female patients in this area, and to probe into the sensitivity of Candida albicans to common azoles and carpofensin in patients with VVC, and to explore the sensitivity of Candida albicans to common azoles and carpofensin. Cipofen combined with aspirin, Effect of verapamil on sensitization of free Candida albicans. Methods: from March 2016 to October 2016, 103 specimens of secretions positive for fungi were collected from suspected VVC patients in outpatient clinic of Shanxi Maternal and Child Health Hospital. Finally 79 strains of Candida albicans were identified by using Comaga chromogenic medium API 20C aux and molecular biology methods. By using M27-A3 microamount liquid based dilution method, 42 strains of Candida albicans were tested for drug sensitivity in vitro. The MIC50 values of Candida albicans to four kinds of antifungal drugs were recorded respectively. The resistance rate of Candida albicans to four kinds of antifungal drugs was calculated and compared, and 42 strains of Candida albicans were tested in vitro by the combination of carbophane, aspirin and verapamil. To observe the MIC50 value of carpofen alone and after combined treatment, to analyze the relationship between the change of MIC50 value and the combination drug, and to further explore the combination of carpofen and aspirin. Whether verapamil can increase the sensitivity of Candida albicans in free state. Results in this experiment, 103 samples of secretions from suspected VVC patients were collected and 101 strains of clinical strains were obtained. Of these, 79 were Candida albicans, 12 were Candida glabra, 4 were Candida tropicalis, 3 were Candida albicans, 3 were Candida albicans, 1 was Candida korgii, and 2 were others. The results of in vitro drug sensitivity test showed that 20 strains were resistant to fluconazole. The drug resistance rate was about 47.6; there were 24 strains with resistance to itraconazole, and the resistance rate was about 57.1; 18 strains had resistance to voriconazole, and the resistance rate was about 42.8; and 13 strains had resistance to captophannet, and the resistance rate was about 30.9.3. kappofen and aspirin, When verapamil was combined with free Candida albicans, the MIC50 values of captophannet decreased from 0.0156-8 渭 g / mL to 0.0156-4 渭 g / mL. Statistical analysis of MIC50 values before and after combined therapy showed that the MIC50 values of carpofen, aspirin and verapamil were in accordance with normal distribution by normal test, and t test was used. Results the mean 卤standard deviation (sx 卤) was 2.47 卤2.97) in carpofen alone group, which was higher than that in carpofen combined with aspirin group (0.75 卤1.08). The difference was statistically significant (P < 0.05). The difference was statistically significant (2.47 卤2.97) in carpofen alone group than that in carpofen and verapamacil group (2.47 卤2.97). The difference was statistically significant in the rice combination group (0.68 卤1.09), and the difference was statistically significant (P < 0.01). ConclusionCandida is the main pathogen in VVC patients, Candida albicans is still the main pathogen, Candida albicans is more sensitive to carpofentine than that of common oxazoles. The resistance rate of Candida albicans to carpofen is lower than that of fluconazole and volconazole, and the resistance rate of Candida albicans to carpofen is lower than that of fluconazole. Itraconazole. 3, aspirin, verapamil and carpofen can increase the sensitivity of carpofentine to free Candida albicans. Both drugs can be used as sensitizers for carpofensin and provide a new strategy for the treatment of VVC.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.31

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