曲霉菌临床分离株的分子鉴定及体外抗真菌药物敏感性分析  

Molecular identification and antifungal susceptibility in clinical isolates of Aspergillus species

作　　者：张莉莉[1] 王强兄 沈亮亮[1] 冀燕芬 邓淑文 赵敬军[1] ZHANG Li-li;WANG Qiang-xiong;SHEN Liang-liang;JI Yan-fen;DENG Shu-wen;ZHAO Jing-jun(Dept.of Dermatology,Tongji Hospital,Tongji University,Shanghai 200065,China;Institute of Medical Mycology-Shanghai Key Laboratory of Mocology,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)

机构地区：[1]同济大学附属同济医院皮肤科,上海200065 [2]上海长征医院皮肤病与真菌病研究所-上海市医学真菌重点分子生物学实验室,上海200003

出　　处：《同济大学学报（医学版）》2018年第1期70-75,共6页Journal of Tongji University(Medical Science)

基　　金：上海市自然科学基金(16ZR1432400)

摘　　要：目的研究曲霉菌临床分离株的分子鉴定及体外抗真菌药物的敏感性。方法采用Internal Transcribed Spacer(ITS)及β-tubulin基因部分测序对临床分离的53株经形态学鉴定为曲霉的菌株进行分子鉴定,并按照美国临床实验室标准化协会(CLSI)推荐的M38-A2微量液基稀释法测定唑类(伊曲康唑、伏立康唑、泊沙康唑),两性霉素B和棘白菌素类(米卡芬净、阿尼芬净和卡泊芬净)共7种抗真菌药物对所有菌株的最低抑菌浓度(minimum inhibitory concentration,MIC)或最低有效浓度(minimum effective concentration,MEC)。结果 53株曲霉菌包含烟曲霉复合体22株(烟曲霉21株和仑图卢斯曲霉1株),黑曲霉复合体23株(塔宾曲霉16株、黑曲霉5株和百岁兰曲霉2株)及土曲霉和黄曲霉各4株;米卡芬净、阿尼芬净、卡泊芬净、泊沙康唑、伏立康唑、伊曲康唑、两性霉素B对曲霉菌株的MIC_(90)为0.031、0.031、0.25、0.5、0.5、1、2μg/mL。除1株烟曲霉对伊曲康唑(MIC≥16μg/mL)和伏立康唑(MIC为2μg/m L)耐药及1株仑图卢斯曲霉对两性霉素B耐药(MIC为8μg/m L)外,其余菌株对7种药物均敏感。4种曲霉复合体对7种抗真菌药物的敏感性差异有统计学意义(P<0.05)。结论棘白菌素类药物体外抗曲霉菌活性最好,两性霉素B体外抗曲霉菌活性相对较差,唑类药物介于以上两者之间。不同种曲霉菌对不同抗真菌药物的敏感性存在差别。Objective To investigate the molecular identification and susceptibility to antifungal agents of clinical isolates of Aspergillus species.Methods Fifty-three clinical isolates of Aspergillus were identified to species level based on Internal Transcribed Spacer(ITS)andβ-tubulin gene sequencing.The in vitro susceptibility to anidulafungin,caspofungin,micafungin,posaconazole,voriconazole,itraconazole and amphotericin B was tested by CLSI M38-A2.Results Among 53 isolates,there were 21 strains of Aspergillus fumigatus,16 of Aspergillus tubingensis,5 of Aspergillus niger,4 of Aspergillus flavus,4 of Aspergillus terreus,2 of A.welwitschiae and 1 of A.lentulus.The MIC 90 of micafungin,anidulafungin,caspofungin,posaconazole,voriconazole,itraconazole,amphotericin B were 0.031,0.031,0.25,0.5,0.5,1 and 2μg/mL.One Aspergillus fumigatus strain showed resistance to itraconazole and voriconazole.Aspergillus lentulus strain was resistant to Amphotericin B.Other strains were sensitive to 7 antifungal angents.The susceptibility of 4 species complexes to different antifungal drugs was statistically significant differences(P<0.05).Conclusion Echinocandins drugs have best antifungal activity against 5 Aspergillus species,followed by asoles and amphotericin B.Different species of Aspergillus show different patterns of antifungal susceptibility.

关 键 词：曲霉菌 抗真菌药物敏感性试验 微量液基稀释法 

分 类 号：R756[医药卫生—皮肤病学与性病学]