【摘要】：目的：甲真菌病（onychomycosis）是由各種真菌引起的甲板或甲下組織的慢性感染。皮膚癬菌（dermatophytes）、酵母菌（yeast）和非皮膚癬菌霉菌（nondermatophyte moulds, NDM）均可引起甲真菌病，其中皮膚癬菌引起的甲真菌病稱(chēng)為甲癬（tinea unguium）。甲真菌病在人群中普遍存在，我國(guó)曾有調(diào)查顯示甲真菌病患病率為5.69%[1]。 甲真菌病的流行病學(xué)情況與多種內(nèi)外因素相關(guān)�；颊叩哪挲g、性別、遺傳背景、生活習(xí)慣以及不同的時(shí)間、地域、氣候環(huán)境等因素都與甲真菌病的流行相關(guān)。流行病學(xué)調(diào)查對(duì)于甲真菌病的防治非常重要：患病影響因素的調(diào)查有助于疾病預(yù)防工作的開(kāi)展；臨床分型、病原菌的組成分布有助于個(gè)體化診療方案的制定。 石家莊市地處華北平原中部，屬溫帶大陸性氣候，人口流動(dòng)性大，外來(lái)人口較多，既往甲真菌病流行病學(xué)研究資料較少。本文通過(guò)對(duì)我院一年內(nèi)門(mén)診甲真菌病的臨床分型、病原菌分類(lèi)及患病相關(guān)因素的調(diào)查研究，闡釋了本地區(qū)甲真菌病流行病學(xué)的部分情況。 方法： 1選取2011年1月~12月，在河北醫(yī)科大學(xué)第四醫(yī)院皮膚性病科門(mén)診初診為甲真菌病的患者�；颊咝柰瑫r(shí)符合以下2個(gè)條件：①臨床表現(xiàn)：甲增厚、甲變色、甲分離或甲脆變等疑似甲真菌病的甲改變。②病甲真菌培養(yǎng)陽(yáng)性。 2選取患者最嚴(yán)重的病甲作為靶甲，取靶甲組織采用多點(diǎn)培養(yǎng)法進(jìn)行真菌培養(yǎng)。對(duì)陽(yáng)性菌株鑒定到種，具體鑒定方法包括：觀察菌落形態(tài)、酚棉蘭染色、尿素酶試驗(yàn)、芽管試驗(yàn)、科馬嘉試驗(yàn)、小培養(yǎng)。 3由一名固定醫(yī)師對(duì)靶甲進(jìn)行臨床分型，詢(xún)問(wèn)患病相關(guān)因素，并記錄入調(diào)查表中。 4匯總所有數(shù)據(jù)，運(yùn)用SPSS軟件對(duì)數(shù)據(jù)進(jìn)行分析處理得出結(jié)果。 結(jié)果： 1本研究共有106例患者真菌培養(yǎng)結(jié)果為陽(yáng)性被納入研究對(duì)象，其中男性30例，女性76例。患者年齡范圍在2歲至79歲，中位年齡38歲。病程最短1個(gè)月，最長(zhǎng)40年，中位病程12個(gè)月。 2患者中僅累及指甲的25例，僅累及趾甲73例，同時(shí)累計(jì)指趾甲的8例。病甲數(shù)目最多20個(gè)，最少1個(gè)。1~2個(gè)甲受累的例數(shù)占總就診病例數(shù)目的55.66%，3~5個(gè)甲受累的例數(shù)占總就診病例數(shù)目的27.36%。5個(gè)以上甲受累的病例數(shù)占總就診病例數(shù)目的16.98%。 3對(duì)患者的年齡（歲）、病程（月）和病甲數(shù)目（個(gè)）進(jìn)行兩兩的相關(guān)性分析。結(jié)果：①年齡與病程存在正相關(guān)，即年齡越大，病程越長(zhǎng)；②病甲數(shù)目與病程存在正相關(guān)，即病程越長(zhǎng)，病甲數(shù)目越多。 4臨床分型：遠(yuǎn)端側(cè)位甲下型（47.52%）和全甲毀損型（44.55%）在臨床中較常見(jiàn)。而近端甲下型（4.95%）和白色表淺型（2.97%）臨床比較少見(jiàn)。 5甲改變及伴隨癥狀：甲真菌病常見(jiàn)甲外觀的改變有變色、變厚、變脆易碎、變硬、甲分離。其中以變色最為常見(jiàn)，達(dá)到病例總數(shù)的84.91%，顏色改變以白色、黑色、黃色較為常見(jiàn)，部分病甲也可不伴有顏色的變化。甲真菌病的伴隨癥狀有疼痛（15.09%）和壓痛（16.98%）。 6菌株組成：培養(yǎng)共得111株真菌，其中皮膚癬菌72株（64.9%），酵母菌34株（30.6%），非皮膚癬菌霉菌5株（4.5%）。紅色毛癬菌47株（42.34%），須癬毛癬菌19株（17.12%），白念珠菌14株（12.61%）。單獨(dú)感染101例，占95.28%；混合感染5例，均為兩種真菌的混合感染，菌株的構(gòu)成分別為：紅色毛癬菌合并白念珠菌，紅色毛癬菌合并光滑念珠菌，紅色毛癬菌合并克柔念珠菌，須癬毛癬菌合并光滑念珠菌，熱帶念珠菌合并紅酵母。 結(jié)論： 1門(mén)診就診患者年齡主要分布在20~50歲，病程長(zhǎng)短差距較大。80%以上患者病甲數(shù)目在5個(gè)以?xún)?nèi)。患者年齡與病程，病甲數(shù)目與病程長(zhǎng)短均呈正相關(guān)。 2本次研究的甲真菌病臨床分型主要以遠(yuǎn)端側(cè)位甲下型及全甲毀損型最多見(jiàn)，，近端甲下型、白色表淺型相對(duì)少見(jiàn)。 3本次研究的甲真菌病分離所得病原菌株以皮膚癬菌為主，酵母菌次之，NDM較少見(jiàn)。單獨(dú)感染占到甲真菌病的絕大部分，混合感染較少見(jiàn)，多數(shù)混合感染為皮膚癬菌合并酵母菌的感染。 4社會(huì)因素對(duì)于甲真菌病的流行病學(xué)有著不容忽視的影響。
[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,
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R756

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