發(fā)布時(shí)間：2018-01-23 01:55

  本文關(guān)鍵詞： 馬爾尼菲青霉菌 寄生株 臨床人分離株 抗真菌藥物 體外藥敏試驗(yàn)　出處：《廣西醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的為臨床選擇高效低毒的抗真菌藥物治療馬爾尼菲青霉病(Penicilliosis marneffei, PSM)提供理論參考,并據(jù)此實(shí)驗(yàn)結(jié)果分析和探討馬爾尼菲青霉菌(Penicillium marneffei, PM)竹鼠寄生株與臨床人分離株的相關(guān)性,為PSM的傳播途徑和致病機(jī)制的研究提供理論參考。 方法按臨床實(shí)驗(yàn)室標(biāo)準(zhǔn)委員會(CLSI,原稱NCCLS)頒布的M27-A2和M38-A方案采用新型抗真菌藥物伏立康唑(voriconazole, VCZ)與常用抗真菌藥物伊曲康唑(Itraconazole, ICZ)、氟康唑(Fluconazole, FCZ)、特比奈芬(Terbinafine, TBF)及兩性霉素B(Amphotericin B, AMB)同時(shí)對PM廣西野生竹鼠寄生株14株與臨床人分離株25株的菌絲相(25°C)和酵母相(37°C)進(jìn)行體外抗真菌藥敏試驗(yàn),測定各藥分別在兩種溫度相下對兩種不同來源菌株的最小抑菌濃度(MIC值),縱向比較同一溫度下PM臨床人分離株與寄生株對同一藥物的MIC值的差異,橫向比較兩種不同來源菌株分別在酵母相和菌絲相下對同一種藥物的MIC值的差異,分析和探討新型抗真菌藥物VCZ與4種常用抗真菌藥物對PM的敏感性差異,并分析PM竹鼠寄生株與臨床人分離株的相關(guān)性。另外討論25株P(guān)M臨床人分離株酵母相的體外抗真菌藥敏試驗(yàn)結(jié)果與其臨床患者的治療效果的關(guān)系,以此分析體外抗真菌藥敏試驗(yàn)的臨床意義。 結(jié)果(1)PM臨床人分離株與竹鼠寄生株在新型抗真菌藥物VCZ的作用下其MIC值在本實(shí)驗(yàn)5種藥物中最低,常用抗真菌藥物ICZ和TBF次之,再次是AMB,而FCZ的MIC值最高;(2)同一溫度相下PM臨床人分離株與竹鼠寄生株對同一藥物的MIC值無明顯差異,P0.05;(3)同一菌株分別在菌絲相和酵母相下對同一種抗真菌藥物的MIC值不完全相同;(4)25株P(guān)M臨床人分離株酵母相的體外抗真菌藥敏試驗(yàn)結(jié)果與其臨床患者的治療效果存在異同性。 結(jié)論(1)PM臨床人分離株與竹鼠寄生株對新型抗真菌藥物VCZ的敏感性最強(qiáng),常用抗真菌藥ICZ、TBF次之,AMB為中度敏感,FCZ的敏感性稍差;(2)同一溫度相下PM臨床人分離株與竹鼠寄生株對同一抗真菌藥物的敏感性一致,提示兩種菌株可能存在一定相似性;(3)同一菌株分別在菌絲相和酵母相下對同一種抗真菌藥物的敏感性不完全相同,提示菌相的改變有可能影響PM對部分抗真菌藥物的敏感性;(4)體外抗真菌藥敏試驗(yàn)結(jié)果對臨床治療PSM的藥物選擇僅提供參考性。
[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 擄C) and 37 擄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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R379

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