成都地区RVVC患者致病菌种体外药敏试验与真菌表型转换的相互关系  

The correlation between drug-susceptibility testing of fungal species and phenotypic conversions in patients with recurrent vulvovaginal candidiasis in Chengdn area

作　　者：唐袁婷[1] 胡正强[1] 刘宏伟[2] 岳新爱[1] 周伟[1] 旷凌寒[1] 

机构地区：[1]四川大学华西第二医院临床检验科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [2]四川大学华西第二医院妇产科,成都610041

出　　处：《重庆医学》2017年第A01期21-23,共3页Chongqing medicine

基　　金：四川省科技厅支撑项目（2013SZ0037）.

摘　　要：目的探讨成都地区复发性外阴阴道假丝酵母菌病（RVVC）患者致病菌种体外药敏试验与真菌表型转换的相互关系，为指导临床用药提供依据。方法选取2014年1月至2015年11月在该院就诊且经临床及实验室诊断为RVVC的患者90例，取阴道分泌物经阴道微生态检查、真菌培养、鉴定及体外药敏试验，分析RVVC患者体外药敏情况及与病原真菌表型转换的相互关系。结果引起RVVc的致病菌主要为白假丝酵母菌，占60．00％（54／90），其中查见菌丝相患者49例（发生表型转换阳性率为90．74％）；非白假丝酵母菌感染36例，占40．OO％，其中未见菌丝相（未发生表型转换）者33例，占91．67％（33／36），二者比较差异无统计学意义（X^2-0．023，P=0．880）。在体外药敏试验中白假丝酵母菌对二性霉素B、5-氟胞嘧啶敏感性为100．00％，对伏立康唑、氟康唑、伊曲康唑敏感性依次为85．19％、75．93％、75．93％；非白假丝酵母菌对二性霉素B、5-氟胞嘧啶、伏立康唑、氟康唑、伊曲康唑的敏感性依次为97．22％、97．22％、69．44％、33．33％、30．56％。结论成都地区引起RVVC的主要病原菌为白假丝酵母菌，一般均发生了真菌表型转换；其次为非白假丝酵母菌，一般不发生表型转换。白假丝酵母对抗真菌药物菌敏感性均高于非白假丝酵母菌，因此应重视非白假丝酵母菌对抗真菌药物的耐药性。Objective The aim of this study was to investigate the correlation between drug-suscepttblllty testing ot Iungal spe- cies and phenotypic conversions in patients with recurrent vulvovaginal candidiasis （RVVC） in Chengdu area,China. Methods 90 patients with RVVC who were admitted to the West China Second University Hospital,Sichuan University from January 2014 to November 2015 were enrolled in this study retrospectively. Vaginal samples were collected from these patients to examine vaginal micro-ecosystem, fungal culture and identification,drug-susceptibility testing, and to analyze the drug-susceptibility testing in vitro, phenotypic conversions and the fungal species in patients with RVVC. Results Candida albicans was the most common species of pathogen induced to RVVC（60.00% ,54/90） ,among which 49 cases were with pseudohyphae（90.74%）. 36 patients were infected with non-Candida albicans species （40.00 %）, among which 33 cases were without pseudohyphae （91.67 %）, the difference of this two rates was considered no statistical signifieant（P〉0.05）. In drug-susceptibility testing in vitro, Candida albicans was susceptible to Amphotericin B（ 100.00 % ）, 5-fluorocytosine（100 % ）. The susceptibility rates to fluconazole, voriconazole, itraconazole were 85. 19 %,75.93% and 75. 93% respectively; the susceptibility rates of non-Candida albicans species to Amphotericin B, 5-fluorocy- tosine,fluconazole,voriconazole,itraconazole were 97.22%,97.22% ,69.44% ,33.33% and 30.56% respectively. Conclusion The main pathogenic fungus in Chengdu area,China leading to RVVC was Candida albicans, and the fungal phenotype conversion had occurred in almost all of them;followed by non-Candida albicans species, and the phenotype conversion had occurred scarely. To dif- ferent antifungal drugs,the drug-susceptibility of Candida albicans was higher than those of non-Candida albicans. Therefore, the drug resistance of non Candida albicans should be naid more attention.

关 键 词：外阴阴道假丝酵母菌病 酵母相 菌丝相 药敏实验 耐药性 

分 类 号：R734.2[医药卫生—肿瘤]