中国大陆地区暗色丝孢霉病（1987年-2017年）回顾性分析

发布时间：2018-05-08 18:45

本文选题：暗色丝孢霉病 + 诊断　；参考：《北京协和医学院》2017年硕士论文

【摘要】：全文主要包括两部分内容:第一部分:中国大陆地区暗色丝孢霉病(1987年-2017年)回顾性分析目的总结和探讨中国大陆地区近30年暗色丝孢霉病的流行病学和诊治状况,并对国内外暗色丝孢霉病相关研究进行对比分析。方法通过CNKI、万方、维普、Embase和Pubmed检索1987年至2017年中国大陆地区暗色丝孢霉病相关文献,进行数据分析和总结。结果本文共纳入文献107篇,共计有116例患者为暗色丝孢霉病。其中暗色丝孢霉病感染临床类型以皮肤及皮下组织型为主,其他感染临床类型包括系统性、角膜型、浅表型感染和甲暗色丝孢霉病等。该病诱因以上皮屏障被破坏、特发性免疫功能异常最为多见,其次为长期系统使用糖皮质激素和免疫抑制剂,提供相关信息但未发现诱因及基础疾病的患者占32.65%(32/98)。病原学诊断主要依据真菌镜检、组织病理、真菌培养和分子鉴定,有超过1/2的病例(62株菌)进行了分子生物学鉴定,有近1/3的病例(45株菌)进行了体外药敏试验。治疗上我国以系统性抗真菌治疗为主,伊曲康唑为近20年来该病最常用药。107例提供预后信息的患者中因该病死亡10例,占9.35%(10/107);其中以中枢神经系统型死亡率最高,共6例,占此型已知预后人数的75%(6/8)。结论近年来,中国大陆地区暗色丝孢霉病感染数有明显上升趋势。感染类型以皮肤及皮下组织感染为主,若累及中枢神经系统死亡率较高。各科医生应提高该病各型临床及病原诊断水平,及早诊断,及时治疗,并积极开展分子鉴定,同时尽可能行体外药物敏感性试验,为临床治疗提供更为有效的参考信息。第二部分:Sensititre YeastOne(?)显色药敏板检测暗色真菌体外药物敏感性的应用研究目的评价不同暗色真菌临床分离株的抗真菌药物敏感性,并为建立Sensititre YeastOne(?)显色药敏板检测暗色真菌的体系提供参考方法收集不同来源的7属10种50株暗色真菌进行YeastOne药敏试验,并与CLSIM38-A的标准化方法进行比较。结果本研究所纳入的暗色真菌对临床上常用抗真菌药物敏感性基本与国内外文献报道结果相符,YeastOne方法和CLSI M38-A方法对非棘白菌素类抗真菌药物的基本符合率较高。结论YeastOne方法测试非棘白菌素类药物时和标准化方法比较有较好的一致性和可重复性,值得在临床上推广应用;采用YeastOne方法测试棘白菌素类药物对丝状真菌的药敏时通过观察MEC更准确。
[Abstract]:This paper mainly includes two parts: the first part: a retrospective analysis of dark filamentosis in mainland China (1987-2017) objective to summarize and discuss the epidemiology, diagnosis and treatment of dark filamentosis in mainland China in recent 30 years. The relative studies on dark filamentous mildew at home and abroad were compared and analyzed. Methods by CNKI, Wanfang, Embase and Pubmed, we searched the literatures of Chinese mainland from 1987 to 2017, and analyzed and summarized the data. Results A total of 107 articles were included in this paper. 116 patients were diagnosed as filamentomycosis. The clinical types of dark filamentous infection were mainly skin and subcutaneous tissue, and the other types of infection included systemic, corneal, superficial and dermatocystis. The abnormal idiopathic immune function was the most common, followed by long-term systemic use of glucocorticoids and immunosuppressants. The number of patients who provided relevant information but found no inducement and underlying diseases accounted for 32.65% of 98%. The etiological diagnosis was mainly based on microscopic examination of fungi, histopathology, fungal culture and molecular identification. More than 1 / 2 of the cases (62 strains) were identified by molecular biology, and nearly a third of the cases (45 strains) were tested for drug sensitivity in vitro. In our country, systemic antifungal therapy is the main treatment in our country. Itraconazole is the most common drug for the disease in the past 20 years. Among the 107 patients who provide prognostic information, 10 cases (9.3535 / 10 / 107) died because of the disease, among which the central nervous system type mortality rate was the highest (6 cases). It accounts for 75 / 8 of the number of known prognoses in this type. Conclusion in recent years, the infection number of filamentomycetes dark-colored in mainland China has an obvious upward trend. The type of infection was mainly skin and subcutaneous infection, and the death rate of central nervous system involved was higher. Doctors should improve the level of clinical and pathogenic diagnosis of the disease, early diagnosis, timely treatment, active molecular identification, and as much as possible to carry out in vitro drug sensitivity test, to provide more effective reference information for clinical treatment. Part II: Sensititre YeastOne /) Application of color sensitive plate in detection of drug sensitivity of dark fungi in vitro objective to evaluate the antifungal susceptibility of different clinical isolates of dark colored fungi and to establish Sensititre YeastOne. The system of detecting dark color fungi by color sensitive plate provides a reference method to collect 10 species and 50 strains of dark color fungi from 7 genera from different sources for YeastOne susceptibility test and compare with the standardized method of CLSIM38-A. Results the sensitivity of dark fungi to common antifungal drugs in our study was basically consistent with the results reported in domestic and foreign literatures. The results of YeastOne method and CLSI M38-A method were higher than those of CLSI M38-A method for non-Echinoctonin antifungal drugs. Conclusion there is good consistency and reproducibility between the YeastOne method and the standardized method, so it is worth popularizing and applying in clinic. It was more accurate to observe MEC when using YeastOne method to test the susceptibility of Echinocillin to filamentous fungi.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R756

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