本文關(guān)鍵詞： 馬拉色菌 流行病學(xué) 山蒼子油 抗真菌藥物 體外聯(lián)合藥敏試驗(yàn)　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的1、了解昆明地區(qū)三種馬拉色菌皮膚病即花斑癬、馬拉色菌毛囊炎、脂溢性皮炎菌種分布情況和易感因素,為預(yù)防馬拉色菌感染及減少發(fā)病率提供依據(jù)；2、研究山蒼子油抗馬拉色菌的活性及分別與氟康唑、伊曲康唑及酮康唑聯(lián)合抗真菌效力,為臨床治療馬拉色菌引起的相關(guān)疾病選擇新型高效低毒的治療藥物和治療方案提供理論依據(jù)。 方法1.收集臨床典型、真菌鏡檢陽性的花斑癬、馬拉色菌毛囊炎、脂溢性皮炎(頭皮屑)的病例,并進(jìn)行馬拉色菌培養(yǎng)和鑒定,分析馬拉色菌菌種構(gòu)成情況,同時(shí)用自制調(diào)查表對入選病例進(jìn)行易感因素調(diào)查。2.參照美國國家臨床試驗(yàn)標(biāo)準(zhǔn)化委員會(NCCLS)提出的M27-A方案,測定山蒼子油對臨床分離優(yōu)勢菌株的最小抑菌濃度(MIC值)。3.同時(shí)測定了山蒼子油與酮康唑、伊曲康唑、氟康唑分別聯(lián)合抗馬拉色菌的MIC值,對三種抗真菌藥物與山蒼子油聯(lián)合用藥前后的MIC值進(jìn)行統(tǒng)計(jì)學(xué)分析比較。 結(jié)果1.共收集158例病例,男104例,女54例,平均年齡29.4歲,多汗、油性皮膚患者所占比例均超過60%,培養(yǎng)到111株馬拉色菌,分離出6個(gè)菌種：糠秕馬拉色菌38株、合軸馬拉色菌29株、厚皮馬拉色菌20株、限制馬拉色菌11株、斯洛菲馬拉色菌7株、鈍形馬拉色菌6株,優(yōu)勢菌株87株。2.山蒼子油對臨床分離的87株馬拉色菌的優(yōu)勢菌株(糠秕、合軸、厚皮)MIC值范圍為625～20000μg/ml,MIC均值為3130.76±846.752μg/ml,合軸馬拉色菌、厚皮馬拉色菌、糠秕馬拉色菌的MIC平均值存在差異,糠秕馬拉色菌的MIC平均值明顯低于合軸及厚皮馬拉色菌,差異有統(tǒng)計(jì)學(xué)意義(p0.05)；3.三種唑類抗真菌藥對馬拉色菌臨床分離株的MIC值范圍、MIC50和MIC90值有一定差別,三種唑類抗真菌藥對馬拉色菌敏感性由高到低分別為：伊曲康唑、酮康唑、氟康唑；4.山蒼子油分別與酮康唑、伊曲康唑、氟康唑聯(lián)合用藥時(shí)各藥物的MIC均值均比單用時(shí)有顯著降低,具有統(tǒng)計(jì)學(xué)差異(P0.01)；0.5FICI≤1,聯(lián)合應(yīng)用有相加作用。 結(jié)論1.馬拉色菌感染好發(fā)于男性青壯年,油性皮膚及多汗的患者更易發(fā)生花斑癬及馬拉色菌毛囊炎,糠秕、合軸、厚皮馬拉色菌為本地區(qū)馬拉色菌感染的優(yōu)勢菌種,各疾病的優(yōu)勢菌種及菌種分布間存在差異；2.山蒼子油對馬拉色菌有抗真菌作用；3.3種唑類抗真菌藥對不同馬拉色菌菌種的敏感性有所不同；4.山蒼子油與氟康唑、伊曲康唑、酮康唑有聯(lián)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，

本文編號：1555984