甲真菌病临床特点及致病菌谱的研究

摘要

Objective To assess the epidemiologic features of nails such as age of onset, clinical morphologic patterns, predisposing factors and pathogenic bacterium profile. Methods Photographs of 328 nail samples collected (luring December 2010 and December 2011 in our hospital were taken and fungal examinations were preformed (direct microscopic examination and fungal cultivation). Clinical morphologic patterns were noted for all positive patients in fungal examinations. 113 patients completed the questionnaires to investigate the predisposing factors. Results In 328 onychomycosis nail samples, incidence rate of male patients was higher than that of female patients (a ratio of 1.45: 1). The most frequently infected patients were in 20 -29 year-old-age group (35.7%). In 370 ungual clinical morphologic patterns, distal and lateral subungual onychomycosis was the most common clinical pattern (51.4% ) , followed by total dystrophic onychomycosis (24. 3% ), superficial white onychomycosis (18. 6% ) and proximal subungual onychomycosis (5.7% ). Positive results in 196 nail samples cultivation indicated that the most common fungal isolates was dermatophytes (82.7% ) , followed by Candida spp (11.2% ) and nondermatophyte molds (6. 1% ) such as Aspergillus spp, Penicillium spp and Fusarium spp, etc. In dermatophytes, Trichophyton rubrum was the most common isolate, followed by Tricho-phyton mentagrophytes. In Candida spp, Candida albicans was the most common. The predisposing factors in 113 cases included familial infection (11.5%), chronic nephrosis (4.4% ), kidney transplantation (0.9% ), nail trauma (1.8% ), diabetes mellitus (1.8% ), leukemia (0.9% ) and idiopathic thrombocytopenic purpura (0.9% ). Conclusion The recognition of the epidemiologic features and clini-comycologic profile of onyehomycosis can help to guide therapeutic approach and preventative measures.%目的 探讨甲真菌病流行病学特点如发病年龄、临床形态学分型、易感因素,以及致病菌谱状况.方法 对2010年12月-2011年12月我院328例甲真菌病的病甲进行拍照和真菌检查(包括直接镜检、真菌培养),并对所有真菌检查阳性患者进行临床形态学分型,其中113例填写调查问卷调查易感因素.结果 328例甲真菌病统计结果显示,男性发病率高于女性,男女比例为1.45:1,最主要的发病年龄为20～ 29岁(35.7％).370例指甲及趾甲的临床形态学分型中最常见的是远端侧缘甲下型(51.4％),其次为全甲毁损型(24.3％),白色浅表型(18.6％),近端甲下型(5.7％).296例甲标本培养阳性结果中皮肤癣菌最常见(82.7％),其次为念珠菌属(11.2％)和非皮肤癣菌的霉菌(6.1％)如曲霉属、青霉属、镰刀菌属等.皮肤癣菌中最常见的是红色毛癣菌,其次须癣毛癣菌.念珠菌属中最常见的是白念珠菌.113例经调查显示易感因素为家族性感染(11.5％),慢性肾病(4.4％)及肾移植(0.9％),糖尿病(1.8％),甲外伤(1.8％),白血病(0.9％)和特发性血小板较少性紫癜(0.9％).结论 临床通过对甲真菌病患者的流行病学特点及菌种分布等情况进行了解,可指导临床治疗及采取相应的预防措施.