摘要
目的通过对健康人和口腔念珠菌病患者口内假丝酵母菌(即念珠菌)株的检测和药物敏感性试验,探讨假丝酵母菌的种类及药敏性,并结合制霉菌素局部疗效的观察,初步探讨最小抑菌浓度(MIC)值与临床疗效的关系,为临床用药提供参考。方法选择61例口腔念珠菌病患者为试验组,43例健康自愿者为对照组,含漱法收集口腔假丝酵母菌标本,采用CHROMagar假丝酵母菌显色培养基对其进行分离鉴定,然后采用NCCLSM27-A微量稀释法测定假丝酵母菌分离株对制霉菌素、酮康唑和氟康唑的MIC值。试验组中选择31例进行制霉菌素治疗,1周后观察临床疗效,并与患者的MIC值作比较。结果①试验组和对照组假丝酵母菌检出率分别为78.69%和30.23%,其中白色假丝酵母菌分别占80.70%和92.31%。②白色假丝酵母菌对氟康唑和酮康唑的MIC值均数间无统计学差异(P>0.05),但唑类药物的MIC值小于制霉菌素。③白色假丝酵母菌对氟康唑、酮康唑和制霉菌素的敏感率分别为95.65%、80.43%和89.13%,少数菌株存在耐药现象。④制霉菌素局部治疗口腔念珠菌病有效率为87.10%,存在少数MIC值与临床疗效结果不一的病例。结论目前口腔假丝酵母菌感染患者口内菌株的耐药现象并不突出,白色假丝酵母菌对氟康唑、酮康唑、制霉菌素的敏感率均较高;酮康唑和氟康唑MIC值较小,提示临床上用制霉菌素治疗疗效欠佳时可换用唑类药物。MIC值与临床疗效存在一定相关性,但MIC值高低与临床疗效并非完全一致。
Objective To understand whether there were any differences of sensitivity to antifungals between the species of Saccharomyces （Candidas） isolated from oral cavity in the patients with oral candidosis and healthy volunteers. Observing the effect of nystatin topically used and discussing preliminarily the relationship between MIC and clinical effect in order to offer reference for clinical treatment. Methods The experiment was carried on 61 patients with candidosis in experimental group and 43 healthy volunteers in control group and isolates of Saccharomyces were obtained by the oral rinse technical method. To isolate and identify Saccharomyces in oral cavity by CHROMagar Saccharomyces culture medium and test the MIC of several antifungal agents such as nystatin, ketoconazole and fluconazole against Saccharomyces by NCCLSM27-A microdilution assay. 31 patients in experimental group were administered with nystatin, observing the clinical effect a week later and comparing the results with the MIC. Results ① The incidence of Saccharomyces was 78.69% and 30.23% in experimental group and control group respectively. The proportion of Saccharomyces albicans was 80.70% （experimental group） and 92.31% （control group）. ②There was no significant difference between the susceptibility of Saccharomyces albicans to fluconazole and ketoconazole （P〉0.05）, but the MIC data of azole antifungals were lower than nystafin. ③The susceptibility of Saccharomyces albicans to fluconazole, ketoconazole and nystatin was 95.65%, 80.43%, and 89.13%, and a few isolates were resistent to antifungal agents. ④The effectiveness of nystatin was 87.10%, and there were a few cases which MIC differs from the clinical effect. Conclusion At present, the resistance of Saccharomyces in patients with oral fungal infection is not significant, most Saccharomyces albicans are sensitive to fluconazole, ketoconazole and nystatin. The MIC of flueonazole and ketoeonazole are lower than nystatin, implying when the clinical effect of nystain is poor, to use an azole an fifungal is optional. The MIC is relative to therapeutic effect to some degree, but it is not consistent completely.
出处
《华西口腔医学杂志》
CAS
CSCD
北大核心
2007年第1期37-41,共5页
West China Journal of Stomatology
基金
国家"十五"科技攻关资助项目(2004BA720A28)
关键词
白色假丝酵母菌
真菌药敏试验
口腔念珠菌病
Saccharomyces albicarts
antifungal susceptibility test
oral candidosis
作者简介
陈方淳（1975-），女，四川人，住院医师，硕士。
【通讯作者】林梅，Tel：028—85503480。
