深圳地区500例HIV/AIDS患者口腔真菌定植状况及药敏研究  

Oral fungal colonization and drug sensitivity of 500 patients with HIV/AIDS in Shenzhen

作　　者：张路坤[1] 曹廷智[1] 孙丽琴[1] 葛风华[2] 王辉[1] 

机构地区：[1]深圳市第三人民医院感染科,深圳市518000 [2]深圳市宝安区中医院口腔科

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第1期84-87,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：深圳市新发传染病重点专科项目(No.2011-61)

摘　　要：目的探索HIV/AIDS患者口腔真菌定植情况、菌种分布以及耐药性,为艾滋病患者真菌感染的防治提供理论依据。方法采用咽拭子法收集500例HIV/AIDS患者的口腔分泌物做真菌培养和药敏测试,同时计数外周血CD4^+T淋巴细胞个数,收集患者高效抗逆转录病毒治疗(HAART)情况。结果 500例HIV/AIDS患者中,存在116例阳性带菌者,阳性率为23.2%,其中白色念珠菌87例(75.0%)。CD4^+T≤350个/μl患者口腔真菌的检出率高于CD4^+T>350个/μl患者(85.34%vs90.89%,P<0.0001)。HIVRNA>500拷贝/ml患者口腔真菌的检出率高于HIVRNA<500拷贝/ml的患者(37.07%vs9.64%,P<0.0001)。接受HAART治疗>2年患者的口腔真菌阳性检出率较HAART治疗<2年患者的口腔真菌阳性检出率低(45.56%vs68.69%,P<0.0001)。从耐药情况看,白色念珠菌、克柔念珠菌、光滑念珠菌和热带念珠菌对多数药物均有较高的耐药性。抗菌效果最好的药物为5-氟胞嘧啶,其次为两性霉素B。结论白色念珠菌为HIV/AIDS患者口腔真菌定植的主要菌种。口腔真菌的定植情况和患者的免疫状态、是否接受HAART治疗有密切关联。5-氟胞嘧啶和两性霉素B的抗菌效果较好。Objective Oral fungal colonization, species distribution and resistance in AIDS patients were detected to provide theoretical evidence for the prevention and treatment of fungal infections during AIDS prossing. Methods The fungal colonization and drug sensitivity status were determined by throat swabs. The oral secretion was isolated from 500 patients with AIDS and the number of CIM ~ T lymphocyte cells in peripheral blood was simultaneously counted. Results There were 116 （23. 2% ） cases with positive fungi infection among the 500 cases with HIV/AIDS. There were 87 cases （75%） with Candida albicans infection in the positive carriers. The oral fungal detection rate in the patients with CD4 ＋ T ≤ 350/Ixl was significantly higher than that in those with CD4 ＋ T 〉 350/μl （85.34% vs 90. 89%, P 〈 0. 0001 ）. The oral fungal detection rate of individuals with HIV RNA 〉 500 copies/ml was significantly higher than that in those with HIV RNA 〈 500 copies/ml （37.07% vs 9.64%, P 〈 0. 0001 ）. The oral fungal positive rate of patients received HAART for longer than 2 years was also higher than that of those received HAART for shorter than two years （45.56% vs 68. 69%, P 〈 0. 0001 ）. Candida albicans, Candida krusei, Candida glabrata and Candida tropicalis were resistant to most anti-fungi drugs. The 5-fluorocytosine and amphotericin B were anti-fungi drugs with the best efficiency. Conclusions Candida albicans is the major strain of oral fungal colonization in HIV/AIDS patients. Oral fungal colonization status is significantly related to patient＇ s immune status and dependent on HAART treatment. The 5-fluorocytosine and amphoteriein B have better antibacterial effect than other drugs in this experiment.

关 键 词：获得性免疫缺陷综合征 口腔真菌 定植 药敏 

分 类 号：R512.91[医药卫生—内科学]