河北医科大学第四医院皮肤性病科门诊甲真菌病的调查分析

发布时间：2018-11-01 13:21

【摘要】：目的：甲真菌病（onychomycosis）是由各种真菌引起的甲板或甲下组织的慢性感染。皮肤癣菌（dermatophytes）、酵母菌（yeast）和非皮肤癣菌霉菌（nondermatophyte moulds, NDM）均可引起甲真菌病，其中皮肤癣菌引起的甲真菌病称为甲癣（tinea unguium）。甲真菌病在人群中普遍存在，我国曾有调查显示甲真菌病患病率为5.69%[1]。甲真菌病的流行病学情况与多种内外因素相关。患者的年龄、性别、遗传背景、生活习惯以及不同的时间、地域、气候环境等因素都与甲真菌病的流行相关。流行病学调查对于甲真菌病的防治非常重要：患病影响因素的调查有助于疾病预防工作的开展；临床分型、病原菌的组成分布有助于个体化诊疗方案的制定。石家庄市地处华北平原中部，属温带大陆性气候，人口流动性大，外来人口较多，既往甲真菌病流行病学研究资料较少。本文通过对我院一年内门诊甲真菌病的临床分型、病原菌分类及患病相关因素的调查研究，阐释了本地区甲真菌病流行病学的部分情况。方法： 1选取2011年1月~12月，在河北医科大学第四医院皮肤性病科门诊初诊为甲真菌病的患者。患者需同时符合以下2个条件：①临床表现：甲增厚、甲变色、甲分离或甲脆变等疑似甲真菌病的甲改变。②病甲真菌培养阳性。 2选取患者最严重的病甲作为靶甲，取靶甲组织采用多点培养法进行真菌培养。对阳性菌株鉴定到种，具体鉴定方法包括：观察菌落形态、酚棉兰染色、尿素酶试验、芽管试验、科马嘉试验、小培养。 3由一名固定医师对靶甲进行临床分型，询问患病相关因素，并记录入调查表中。 4汇总所有数据，运用SPSS软件对数据进行分析处理得出结果。结果： 1本研究共有106例患者真菌培养结果为阳性被纳入研究对象，其中男性30例，女性76例。患者年龄范围在2岁至79岁，中位年龄38岁。病程最短1个月，最长40年，中位病程12个月。 2患者中仅累及指甲的25例，仅累及趾甲73例，同时累计指趾甲的8例。病甲数目最多20个，最少1个。1~2个甲受累的例数占总就诊病例数目的55.66%，3~5个甲受累的例数占总就诊病例数目的27.36%。5个以上甲受累的病例数占总就诊病例数目的16.98%。 3对患者的年龄（岁）、病程（月）和病甲数目（个）进行两两的相关性分析。结果：①年龄与病程存在正相关，即年龄越大，病程越长；②病甲数目与病程存在正相关，即病程越长，病甲数目越多。 4临床分型：远端侧位甲下型（47.52%）和全甲毁损型（44.55%）在临床中较常见。而近端甲下型（4.95%）和白色表浅型（2.97%）临床比较少见。 5甲改变及伴随症状：甲真菌病常见甲外观的改变有变色、变厚、变脆易碎、变硬、甲分离。其中以变色最为常见，达到病例总数的84.91%，颜色改变以白色、黑色、黄色较为常见，部分病甲也可不伴有颜色的变化。甲真菌病的伴随症状有疼痛（15.09%）和压痛（16.98%）。 6菌株组成：培养共得111株真菌，其中皮肤癣菌72株（64.9%），酵母菌34株（30.6%），非皮肤癣菌霉菌5株（4.5%）。红色毛癣菌47株（42.34%），须癣毛癣菌19株（17.12%），白念珠菌14株（12.61%）。单独感染101例，占95.28%；混合感染5例，均为两种真菌的混合感染，菌株的构成分别为：红色毛癣菌合并白念珠菌，红色毛癣菌合并光滑念珠菌，红色毛癣菌合并克柔念珠菌，须癣毛癣菌合并光滑念珠菌，热带念珠菌合并红酵母。结论： 1门诊就诊患者年龄主要分布在20~50岁，病程长短差距较大。80%以上患者病甲数目在5个以内。患者年龄与病程，病甲数目与病程长短均呈正相关。 2本次研究的甲真菌病临床分型主要以远端侧位甲下型及全甲毁损型最多见，，近端甲下型、白色表浅型相对少见。 3本次研究的甲真菌病分离所得病原菌株以皮肤癣菌为主，酵母菌次之，NDM较少见。单独感染占到甲真菌病的绝大部分，混合感染较少见，多数混合感染为皮肤癣菌合并酵母菌的感染。 4社会因素对于甲真菌病的流行病学有着不容忽视的影响。
[Abstract]:Objective: onychomycosis is a chronic infection caused by various fungi on deck or onychomycosis. dermatophytosis, yeast and non-dermatophytosis, ndm can cause onychomycosis, in which the onychomycosis caused by dermatophytes is referred to as onychomycosis. The prevalence of onychomycosis in the population was 5.69%[1]. Epidemiology of onychomycosis and various internal and external factors The patient's age, sex, genetic background, living habits and various factors such as time, region and climate are all related to the prevalence of onychomycosis. Relevant. Epidemiological investigation is very important for the prevention and treatment of onychomycosis: the investigation of the factors affecting the disease helps to carry out the disease prevention work; the clinical classification and the composition distribution of the pathogenic bacteria are helpful for the individualized diagnosis and treatment plan. It is located in central part of the Inner Mongolia Plain, belonging to temperate continental climate, large population mobility, more external population, and previous epidemiological research of onychomycosis. In this paper, the epidemiology of onychomycosis in this area was explained by investigating the clinical classification, the classification of pathogenic bacteria and the factors related to the disease in our hospital within one year. Part of the Case. Method: 1 Select from January to December, 2011, at the fourth hospital of Hebei Medical University, Dermatology Department. Patients diagnosed as onychomycosis. The patient needs to meet the following 2 conditions at the same time: the clinical manifestations of facial paralysis: thickening of nail, discoloration of onychomycosis, separation of armour or embrittlement of onychomycosis A. A. A. A. A. A. A. A. A. A. A. A. change. Positive. The most serious disease A in the patient is taken as the target A, and the target nail group is taken. The method comprises the following steps of: observing colony morphology, phenol cotton and blue staining, and urea enzyme test; a bud tube test, a colma test, and a small culture. 3 a target nail is clinically classified by a fixed physician, Ask the disease-related factors and record in the questionnaire. All data, shipment, Using SP The data were analyzed and processed by SS software. Results: A total of 106 patients with fungal culture were studied in this study. Results Positive was included in the study subjects, including 30 males and females. Sex 76 cases. The patient's age ranged from 2 to 79 years, and the median age ranged from 2 years to 79 years. 38 years old. The course of disease is the shortest one month, up to 40 years, mid-term disease course is 12 months. Only 25 nails were involved, only 73 cases of toenail were involved, and 8 cases of toenail were accumulated. The number of cases was 20, the least 1. The number of patients with 1 ~ 2 nails accounted for 55. 66% of the total number of cases, and the number of 3 ~ 5 nail involvement accounts for 27. 3 of the total number of cases. 6%. The number of cases involving 5 or more patients accounted for 16,98% of the total number of cases. The patient's age (age), course of disease (month) and number of patients (months) were analyzed. The results showed that the age of the patients was positively correlated with the course of the disease, that is, the older the age was. The longer the disease course, the longer the disease course is, the longer the disease course, the more the number of diseases A. 4 clinical classification: far In clinic, the lower type (47. 52%) and the total beetle-damaged type (44. 55%) were found in the end side. It is common that the lower type (4.95%) and the white form (2.97%) of the near-end A are less than that of the white table (2.97%). Change and accompanying symptoms: The change of common armour appearance of onychomycosis has color change, thickened, fragile, fragile, hard, and armour separated. Among them, the color change is most common, reaching the total number of cases 8 4.91%, color change is white, black, yellow is more common, partial disease nail is not accompanied There was a change in color. The concomitant symptoms of onychomycosis had pain (15. 09%) and urinary tract (16.98%). 6 strains consisted of 111 strains of fungi, of which skin tinea 72 strains (64. 9%), 34 strains (30. 6%) of yeast, 5 strains of non-dermatophytes (4. 5%), 47 strains of Trichophyton red. (42. 34%), 19 strains of Trichophyton Trichophyton (17. 12%), 14 strains of Candida albicans (12.61%), 101 cases of single infection, 95. 28%, and 5 cases of mixed infection were mixed infection of two fungi. Trichophyton ruginosa combined with light sliding-bearing bead The fungus, the red trichophyton and the candida albicans are combined, and the Trichophyton trichophyton and the Candida albicans are combined, and the Candida albicans is combined with the red yeast. 1. The patient's age is mainly in the range of 20-50 years, and the disease The number of patients with over 80% of the patients was within 5 months. The age and course of the disease were positively correlated with the duration of the disease. 2 The clinical classification of onychomycosis in this study is mainly based on the type A and all-A lesions on the distal side, at the proximal end A type: The shallow type of white table is relatively rare. The pathogenic bacteria isolated from this study are mainly dermatophytes, and yeast Second, NDM is less common. Individual infection accounts for the vast majority of onychomycosis,
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R756

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