马尔尼菲青霉菌广西野生竹鼠寄生株与临床人分离株体外抗真菌药敏试验研究

发布时间：2018-01-23 01:55

本文关键词： 马尔尼菲青霉菌寄生株临床人分离株抗真菌药物体外药敏试验　出处：《广西医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的为临床选择高效低毒的抗真菌药物治疗马尔尼菲青霉病(Penicilliosis marneffei, PSM)提供理论参考,并据此实验结果分析和探讨马尔尼菲青霉菌(Penicillium marneffei, PM)竹鼠寄生株与临床人分离株的相关性,为PSM的传播途径和致病机制的研究提供理论参考。方法按临床实验室标准委员会(CLSI,原称NCCLS)颁布的M27-A2和M38-A方案采用新型抗真菌药物伏立康唑(voriconazole, VCZ)与常用抗真菌药物伊曲康唑(Itraconazole, ICZ)、氟康唑(Fluconazole, FCZ)、特比奈芬(Terbinafine, TBF)及两性霉素B(Amphotericin B, AMB)同时对PM广西野生竹鼠寄生株14株与临床人分离株25株的菌丝相(25°C)和酵母相(37°C)进行体外抗真菌药敏试验,测定各药分别在两种温度相下对两种不同来源菌株的最小抑菌浓度(MIC值),纵向比较同一温度下PM临床人分离株与寄生株对同一药物的MIC值的差异,横向比较两种不同来源菌株分别在酵母相和菌丝相下对同一种药物的MIC值的差异,分析和探讨新型抗真菌药物VCZ与4种常用抗真菌药物对PM的敏感性差异,并分析PM竹鼠寄生株与临床人分离株的相关性。另外讨论25株PM临床人分离株酵母相的体外抗真菌药敏试验结果与其临床患者的治疗效果的关系,以此分析体外抗真菌药敏试验的临床意义。结果(1)PM临床人分离株与竹鼠寄生株在新型抗真菌药物VCZ的作用下其MIC值在本实验5种药物中最低,常用抗真菌药物ICZ和TBF次之,再次是AMB,而FCZ的MIC值最高;(2)同一温度相下PM临床人分离株与竹鼠寄生株对同一药物的MIC值无明显差异,P0.05;(3)同一菌株分别在菌丝相和酵母相下对同一种抗真菌药物的MIC值不完全相同;(4)25株PM临床人分离株酵母相的体外抗真菌药敏试验结果与其临床患者的治疗效果存在异同性。结论(1)PM临床人分离株与竹鼠寄生株对新型抗真菌药物VCZ的敏感性最强,常用抗真菌药ICZ、TBF次之,AMB为中度敏感,FCZ的敏感性稍差;(2)同一温度相下PM临床人分离株与竹鼠寄生株对同一抗真菌药物的敏感性一致,提示两种菌株可能存在一定相似性;(3)同一菌株分别在菌丝相和酵母相下对同一种抗真菌药物的敏感性不完全相同,提示菌相的改变有可能影响PM对部分抗真菌药物的敏感性;(4)体外抗真菌药敏试验结果对临床治疗PSM的药物选择仅提供参考性。
[Abstract]:Objective to provide a theoretical reference for the clinical treatment of Penicilliosis marneffeii (PSM) with high efficiency and low toxicity antifungal drugs. Based on the experimental results, the relationship between the parasitic strain of Penicillium marneffeii (PM) and the clinical human isolate was analyzed and discussed. To provide a theoretical reference for the study of transmission pathway and pathogenesis of PSM. Methods CLSI was performed according to clinical laboratory standards. The M27-A2 and M38-A protocols, formerly known as NCCLS, used voriconazole, a new antifungal drug, as a new antifungal drug. VCZ and common antifungal drugs Itraconazole, ICZO, Fluconazole, FCZ). Terbinafine (TBF) and amphotericin B Amphotericin B. AMB was used to study the antimicrobial susceptibility of 14 parasitic strains of wild bamboo rodents (PM) and 25 strains of clinical human isolates (25 掳C) and 37 掳C (yeast phase) in vitro. The minimum inhibitory concentration (MIC) of each drug against two strains from different sources was determined under two temperature phases. The MIC values of PM clinical human isolates and parasitic strains on the same drug were compared longitudinally at the same temperature. The MIC values of the same drug in yeast phase and hyphal phase were compared horizontally between the two strains. The sensitivity of new antifungal drug VCZ and four common antifungal drugs to PM was analyzed and discussed. The relationship between parasitic strains of PM bamboo rodents and clinical human isolates was analyzed. In addition, the relationship between the results of in vitro antimicrobial susceptibility test in yeast phase of 25 strains of PM clinical human isolates and the therapeutic efficacy of their clinical patients was discussed. The clinical significance of in vitro antifungal susceptibility test was analyzed. Results the MIC values of clinical human isolates and parasitic strains of Phyllostachys officinalis were the lowest among the five drugs in this experiment under the action of new antifungal drug VCZ, followed by common antifungal drugs ICZ and TBF. The third is Amb, and the MIC value of FCZ is the highest. (2) there was no significant difference in MIC value of PM clinical human isolate and bamboo mouse parasitic strain to the same drug at the same temperature (P 0.05); (3) the MIC values of the same antifungal drug were not identical under the hyphae phase and the yeast phase, respectively. The results of in vitro antimicrobial susceptibility test of 25 strains of PM clinical human isolates were similar to those of its clinical patients. Conclusion the sensitivity of clinical human isolates and parasitic strains of Phyllostachys officinalis to the new antifungal drug VCZ is the strongest, and the second most common antifungal drug is AMB. The sensitivity of FCZ was slightly poor. (2) the sensitivity of PM clinical human isolates to the same antifungal drugs was the same as that of bamboo rodent parasitic strains at the same temperature, which suggested that the two strains might have some similarity. 3) the sensitivity of the same strain to the same antifungal drug was not identical in hyphae phase and yeast phase, suggesting that the change of bacterial phase might affect the susceptibility of PM to some antifungal drugs. 4) the results of in vitro antifungal susceptibility test only provide reference for drug selection in clinical treatment of PSM.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R379

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