本文選題：白念珠菌 + 卡泊芬凈��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1、初步了解本地區(qū)女性患者感染VVC的情況并對(duì)其致病菌的菌種的類型及分布進(jìn)行分析;2、初步探究VVC患者中白念珠菌對(duì)常見唑類藥物和卡泊芬凈的敏感性;3、探究卡泊芬凈聯(lián)合阿司匹林、維拉帕米作用于游離態(tài)白念珠菌是否產(chǎn)生增敏現(xiàn)象。方法:將2016年3月至2016年10月期間,就診于山西省婦幼保健院門診疑似VVC患者納為研究對(duì)象,收起真菌鏡檢為陽性的分泌物標(biāo)本共103株,對(duì)其進(jìn)行連續(xù)真菌培養(yǎng)、傳代后,分別采用科瑪嘉顯色培養(yǎng)基、API 20C AUX及分子生物學(xué)方法對(duì)獲得的念珠菌屬進(jìn)行菌種鑒定,最終得到了白念珠菌79株。采用M27-A3微量液基稀釋法,將抗真菌藥物單藥應(yīng)用對(duì)其中42株白念珠菌進(jìn)行體外藥敏實(shí)驗(yàn),分別將白念珠菌對(duì)四種抗真菌藥物的MIC50值進(jìn)行記錄,計(jì)算并比較白念珠菌對(duì)四種抗真菌藥物的耐藥率;將卡泊芬凈與阿司匹林、維拉帕米聯(lián)合應(yīng)用對(duì)42株白念珠菌進(jìn)行體外藥敏實(shí)驗(yàn),觀察卡泊芬凈單獨(dú)用藥和聯(lián)合用藥后卡泊芬凈的MIC50值,分析其MIC50值的改變與聯(lián)合用藥的關(guān)系,進(jìn)一步探究卡泊芬凈聯(lián)合阿司匹林、維拉帕米分別作用于游離狀態(tài)下的白念珠菌時(shí)是否會(huì)產(chǎn)生增敏現(xiàn)象。結(jié)果:1、本實(shí)驗(yàn)共收集疑似VVC患者的分泌物標(biāo)本103例,最終獲得實(shí)驗(yàn)所需臨床菌株101株,其中白念珠菌占79株(78.22%),光滑念珠菌占12株(11.88%),熱帶念珠菌占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、卡泊芬凈及常見唑類藥物對(duì)42株白念珠菌體外藥敏試驗(yàn)結(jié)果為:有20株菌對(duì)氟康唑產(chǎn)生耐藥現(xiàn)象,耐藥率約為47.6%;有24株菌對(duì)伊曲康唑產(chǎn)生耐藥,耐藥率約為57.1%;有18株菌對(duì)伏立康唑產(chǎn)生耐藥,耐藥率約為42.8%;有13株菌對(duì)卡泊芬凈產(chǎn)生耐藥,耐藥率約為30.9%。3、卡泊芬凈與阿司匹林、維拉帕米聯(lián)合應(yīng)用于游離態(tài)白念珠菌后,卡泊芬凈的MIC50值均由0.0156-8μg/m L降至0.0156-4μg/m L。聯(lián)合用藥前后MIC50值統(tǒng)計(jì)學(xué)分析顯示:卡泊芬凈與阿司匹林、維拉帕米聯(lián)合用藥前后卡泊芬凈的MIC50值,經(jīng)正態(tài)性檢驗(yàn),數(shù)據(jù)均符合正態(tài)分布,采用t檢驗(yàn),結(jié)果用均數(shù)±標(biāo)準(zhǔn)差(sx±)表示。(1)卡泊芬凈單獨(dú)用藥組(2.47±2.97)高于卡泊芬凈與阿司匹林聯(lián)合用藥組(0.75±1.08),t=3.536,P=0.01,差異具有統(tǒng)計(jì)學(xué)意義。(2)卡泊芬凈單獨(dú)用藥組(2.47±2.97)高于卡泊芬凈與維拉帕米聯(lián)合用藥組(0.68±1.09),t=3.677,P=0.01,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1、念珠菌屬是是VVC患者的主要病原菌,白念珠菌仍占主要比例,白念珠菌對(duì)卡泊芬凈的敏感性高于常見唑類藥物。2、白念珠菌對(duì)卡泊芬凈的耐藥率低于氟康唑、伏立康唑、伊曲康唑。3、阿司匹林、維拉帕米與卡泊芬凈聯(lián)用均可以增加卡泊芬凈對(duì)游離態(tài)白念珠菌的敏感性,兩種藥物均可以做為卡泊芬凈的增敏劑,為VVC治療提供新策略。
[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 鹵standard deviation (sx 鹵) was 2.47 鹵2.97) in carpofen alone group, which was higher than that in carpofen combined with aspirin group (0.75 鹵1.08). The difference was statistically significant (P < 0.05). The difference was statistically significant (2.47 鹵2.97) in carpofen alone group than that in carpofen and verapamacil group (2.47 鹵2.97). The difference was statistically significant in the rice combination group (0.68 鹵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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R711.31

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本文編號(hào)：2031134