本文選題：暗色絲孢霉病 + 診斷�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：全文主要包括兩部分內(nèi)容:第一部分:中國大陸地區(qū)暗色絲孢霉病(1987年-2017年)回顧性分析目的總結(jié)和探討中國大陸地區(qū)近30年暗色絲孢霉病的流行病學(xué)和診治狀況,并對國內(nèi)外暗色絲孢霉病相關(guān)研究進(jìn)行對比分析。方法通過CNKI、萬方、維普、Embase和Pubmed檢索1987年至2017年中國大陸地區(qū)暗色絲孢霉病相關(guān)文獻(xiàn),進(jìn)行數(shù)據(jù)分析和總結(jié)。結(jié)果本文共納入文獻(xiàn)107篇,共計有116例患者為暗色絲孢霉病。其中暗色絲孢霉病感染臨床類型以皮膚及皮下組織型為主,其他感染臨床類型包括系統(tǒng)性、角膜型、淺表型感染和甲暗色絲孢霉病等。該病誘因以上皮屏障被破壞、特發(fā)性免疫功能異常最為多見,其次為長期系統(tǒng)使用糖皮質(zhì)激素和免疫抑制劑,提供相關(guān)信息但未發(fā)現(xiàn)誘因及基礎(chǔ)疾病的患者占32.65%(32/98)。病原學(xué)診斷主要依據(jù)真菌鏡檢、組織病理、真菌培養(yǎng)和分子鑒定,有超過1/2的病例(62株菌)進(jìn)行了分子生物學(xué)鑒定,有近1/3的病例(45株菌)進(jìn)行了體外藥敏試驗。治療上我國以系統(tǒng)性抗真菌治療為主,伊曲康唑為近20年來該病最常用藥。107例提供預(yù)后信息的患者中因該病死亡10例,占9.35%(10/107);其中以中樞神經(jīng)系統(tǒng)型死亡率最高,共6例,占此型已知預(yù)后人數(shù)的75%(6/8)。結(jié)論近年來,中國大陸地區(qū)暗色絲孢霉病感染數(shù)有明顯上升趨勢。感染類型以皮膚及皮下組織感染為主,若累及中樞神經(jīng)系統(tǒng)死亡率較高。各科醫(yī)生應(yīng)提高該病各型臨床及病原診斷水平,及早診斷,及時治療,并積極開展分子鑒定,同時盡可能行體外藥物敏感性試驗,為臨床治療提供更為有效的參考信息。第二部分:Sensititre YeastOne(?)顯色藥敏板檢測暗色真菌體外藥物敏感性的應(yīng)用研究目的評價不同暗色真菌臨床分離株的抗真菌藥物敏感性,并為建立Sensititre YeastOne(?)顯色藥敏板檢測暗色真菌的體系提供參考方法收集不同來源的7屬10種50株暗色真菌進(jìn)行YeastOne藥敏試驗,并與CLSIM38-A的標(biāo)準(zhǔn)化方法進(jìn)行比較。結(jié)果本研究所納入的暗色真菌對臨床上常用抗真菌藥物敏感性基本與國內(nèi)外文獻(xiàn)報道結(jié)果相符,YeastOne方法和CLSI M38-A方法對非棘白菌素類抗真菌藥物的基本符合率較高。結(jié)論YeastOne方法測試非棘白菌素類藥物時和標(biāo)準(zhǔn)化方法比較有較好的一致性和可重復(fù)性,值得在臨床上推廣應(yīng)用;采用YeastOne方法測試棘白菌素類藥物對絲狀真菌的藥敏時通過觀察MEC更準(zhǔn)確。
[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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R756

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