丝状真菌的快速鉴定及药敏试验  

Rapid identification and antifungal susceptibility testing of filamentous fungi

作　　者：彭阳[1] 许超[1] 王玉月[1] 何彩珍[1] 许昕[1] 毛易捷[1] 史伟峰[1] PENG Yang XU Chao WANG Yu-yue HE Cai-zhen XU Xin MAO Yi-jie SHI Wei-feng(Department of Laboratory Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China)

机构地区：[1]苏州大学附属第三医院检验科,江苏常州213003

出　　处：《临床检验杂志》2017年第7期486-490,共5页Chinese Journal of Clinical Laboratory Science

基　　金：国家自然科学基金(81572052);江苏省自然科学基金(BK20151178);常州市医学领军人才项目(20101368)

摘　　要：目的评估基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)技术在丝状真菌鉴定中的作用,分析常用抗菌药物对丝状真菌的药敏试验结果。方法收集100株丝状真菌,采用MALDI-TOF MS进行快速鉴定,并与显微镜检查结果进行比对;用E-test法进行丝状真菌药敏试验。结果 MALDI-TOF MS对100株丝状真菌鉴定达到种鉴定水平的有61株(得分≥2.000),达到属鉴定水平的有36株(1.700~1.999),未能鉴定的有3株(<1.700);与镜检结果不一致的有1株。两性霉素B对絮状表皮癣菌的90%最低抑菌浓度(MIC_(90))为0.19μg/m L,而对黄曲霉的MIC_(90)>32μg/m L。伊曲康唑对断发毛癣菌、犬小孢子菌和絮状表皮癣菌的MIC_(90)均<0.38μg/m L,而对黑曲霉的MIC_(90)>32μg/m L。氟康唑对大部分受试菌株的MIC_(90)均>256μg/m L。伏立康唑和卡泊芬净对烟曲霉、黄曲霉、黑曲霉、红色毛癣菌、断发毛癣菌和犬小孢子菌的MIC_(90)分别≤0.38μg/m L和≤1μg/m L。结论 MALDI-TOF MS技术可快速、准确、高通量检测临床分离的丝状真菌。伏立康唑和卡泊芬净对丝状真菌具有较好的抗菌活性。Objective To evaluate the application of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry（ MALDI-TOF MS） technology in the identification of filamentous fungi,and analyze the susceptibility of filamentous fungi to commonly used antibiotics. Methods A total of 100 strains of filamentous fungi were collected and identified rapidly by MALDI-TOF MS. The obtained results were compared with those from microscopic examination. The susceptibility of filamentous fungi was detected by the Etest method. Results Among 100 strains of filamentous fungi identified by MALDI-TOF MS,61 reached to the species level（ score≥2. 000）,36 to the genus level（ score between 〈1. 700 and 1. 999）,and 3 failed to be identified（ score 1. 700）. There was inconsistent results for one strain of filamentous fungi between MALDI-TOF MS and microscopic examination. The MIC90） of amphotericin B against Epidermophyton floccosum was 0. 19 μg/m L,while that against Aspergillus flavus was above 32 μg/m L. The MIC90） of itraconazole against Trichophyton tonsurans,Microsporum canis and Epidermophyton floccosum were all below 0. 38 μg/m L,while that against Aspergillus niger was above 32 μg/m L. The MIC90） of fluconazol were above 256 μg/m L for most of strains. The MIC90） of voriconazole and caspofungin against Aspergillus fumigatus,Aspergillus flavus,Aspergillus niger,Trichophyton rubrum,Trichophyton tonsurans and Microsporum canis were ≤0. 38 μg/m L and ≤1 μg/m L,respectively. Conclusion The MALDI-TOF MS technology may be used to identify the filamentous fungi isolated from clinical specimens quickly,accurately and high-throughput. Voriconazole and caspofungin have effective anti-filamentous fungi activity.

关 键 词：基质辅助激光解吸电离飞行时间质谱 丝状真菌 真菌药敏试验 

分 类 号：R446.5[医药卫生—诊断学]