3种皮肤科杂志10年刊载治疗甲真菌病总结

目的：了解目前国内治疗甲真菌病的方法。方法：对发表在1994～2003年中华皮肤科杂志、临床皮肤杂志、中国皮肤性病学杂志上的治疗甲真菌病的文献逐篇检索。结果：检索出有关治疗甲真菌病的文献108篇。结论：治疗甲真菌病的方法目前以伊曲康唑短程间歇冲击疗法最多，伊曲康唑和特比奈芬序贯法是治疗甲真菌病的发展趋势。     

伊曲康唑致一过性蛋白尿1例

患者 ,男 ,4 0岁 ,因双脚趾甲增厚、变脆、分层呈粉末状 5年 ,来本院皮肤科就诊 ,经真菌镜检阳性 ,诊断为甲真菌病 ,予伊曲康唑胶囊间歇冲击疗法治疗 (即每次 2 0 0mg ,每日两次 ,连服 1周后停药 3周为一疗程 ) ,第一疗程中服药无任何不适 ,其间因“左股表皮囊肿”住院手术治疗     

伊曲康唑短程间歇冲击疗法治疗甲真菌病的疗效

伊曲康唑短程间歇冲击疗法治疗甲真菌病的疗效衡阳市中心医院王继跃１９９３年１２月至１９９５年１２月我们应用伊曲康唑（Ｉｔｒａｃｏｎａｚｏｌｅ）治疗甲真菌病２０例，并进行临床疗效及安全性观察，现报告如下。１临床资料及方法１．１病例选择随机选择门诊甲真菌病...     

3种方法治疗孢子丝菌病疗效对比

目的观察抗真菌药碘化钾、碘化钾联合伊曲康唑、碘化钾联合特比萘芬治疗孢子丝菌病的疗效。方法确诊为孢子丝菌病42例,随机分成三组,每组14例。1组用10%碘化钾10 ml,3次/d,口服;2组用10%碘化钾10ml,3次/d,口服,联合伊曲康唑100 mg,2次/d,口服;3组10%碘化钾10 ml,3次/d,口服,联合特比萘芬250 mg,1次/d口服。按疗效标准观察8周。结果 8周治愈率2组及3组无明显差异(P>0.05)。而2组、3组治愈率均优于1组(P<0.05)。结论证明联合用药能提高疗效,缩短病程。     

本刊论文参考文献书写要求

目的：观察伊曲康唑治疗浅部真菌病临床疗效。方法：有条件选择60例具有典型浅部真菌病临床表现及真菌学检查阳性患者，给予伊曲康唑治疗，4周后复查。结果：60例患者治愈率为70%，总有效率(治愈加显效)为100％。结论：伊曲康唑治疗浅部真菌病患者具有快速、服用简单、疗效确切的特点。     

胸腺五肽联合伊曲康唑治疗复发性外阴阴道念珠菌病疗效观察

目的观察胸腺五肽联合伊曲康唑治疗复发性外阴阴道念珠菌病的临床疗效。方法 60例患者随机分为2组,治疗组采用肌内注射胸腺五肽注射液1mg,隔日1次,10次为1疗程,同时口服伊曲康唑胶囊200mg,连服7d。对照组仅口服伊曲康唑胶囊,方法同治疗组。2组均于下次月经周期第1天开始重复上次治疗,且连续巩固治疗3个月经周期。2组均于治疗结束停药后1、3、6个月复诊并记录患者临床症状及体征、不良反应及真菌学检查结果,以综合评价疗效。结果 30例治疗组患者治疗结束1、3、6有效率分别为75.00%、80.00%、70.00%,明显高于对照组(P<0.05)。结论胸腺五肽联合伊曲康唑治疗复发性外阴阴道念珠菌病安全有效,可降低复发率。     

威尼克何德霉感染14例

目的报道14例威尼克何德霉感染的临床特征与体外药敏试验结果,为临床诊疗提供依据。方法取患者皮损(皮/甲屑)镜检和培养,通过测序确定菌种并进行药敏试验,同时分析患者的感染途径、临床特征和抗真菌治疗效果。结果14例患者分离的14株真菌经测序鉴定均为威尼克何德霉,药敏试验结果显示5种抗真菌药物的MIC几何均值为:伊曲康唑0.065 7 mg/L,伏立康唑0.036 3 mg/L,特比萘芬0.038 1 mg/L,酮康唑0.048 8 mg/L,氟康唑3.281 3 mg/L。患者的感染途径大部分与密切接触含盐的沙土有关,特比萘芬和酮康唑擦拭皮损部位1周内有明显疗效,伊曲康唑对于甲感染的治疗效果欠佳。结论威尼克何德霉是掌黑癣的致病菌外,还可引起甲真菌病。体外药敏试验结果显示伊曲康唑、伏立康唑、特比萘芬、酮康唑、氟康唑对该菌的MIC值均较低,这些药物在临床上治疗威尼克何德霉感染导致的掌黑癣均具有明显疗效。     

中西医结合治疗念珠菌性阴道炎的疗效评价

目的:探讨伊曲康唑联合中草药在念珠菌性阴道炎患者中的治疗效果。方法:232例念珠菌性阴道炎患者分为两组,治疗组120例,采用伊曲康唑+中草药联合治疗,对照组112例,单用伊曲康唑治疗,分别于治疗后15d和45d判断疗效和复发情况。结果:(1)治疗组的有效率为96.67%,对照组的有效率为78.57%,两组比较差异有显著性(P<0.05);(2)治疗组复发率为10.00%,对照组复发率为21.43%,治疗组明显低于对照组(P<0.05)。结论:伊曲康唑联合中草药治疗念珠菌性阴道炎患者值得临床推广。     

盐酸布替萘芬乳膏治疗浅部真菌病的临床观察

目的：观察盐酸布替萘芬乳膏治疗浅部真菌病的临床疗效。方法：我们对80例门诊患者使用盐酸布替萘芬乳膏早、晚各1次。并在治疗开始、中间、结束和2周随访时记录症状及真菌学检查结果，并监测不良反应。结果：80例患者在联合用药1、2周。痊愈率为82．5％、93．75％。结论：盐酸布替萘芬乳膏治疗浅部真菌病安全。有效。     

氟康唑胶囊联合萘替芬酮康唑乳膏治疗甲真菌病临床疗效观察

目的观察氟康唑胶囊联合萘替芬酮康唑乳膏治疗甲真菌病的临床效果。方法根据就诊先后顺序,将100例甲真菌病患者分为试验组和对照组,每组各50例。试验组患者年龄18～64岁,平均年龄41岁;病程8个月～6年。对照组患者年龄18～58岁,平均年龄27.9岁;病程3～31年。试验组患者口服氟康唑150mg,1次/周,加外用萘替芬酮康唑乳膏,疗程24周。对照组患者口服伊曲康唑200mg,1次/d,7d/月,疗程24周。结果治疗后24周,试验组痊愈率为60.0%,有效率为90.0%;对照组痊愈率为62.0%,有效率为92.0%。两组痊愈率、有效率经统计学分析差异均无统计学意义（P〉0.05）。结论口服氟康唑联合外用萘替芬酮康唑乳膏,疗效最佳且费用较低,值得在临床中推广使用。     

Treating onychomycosis

Onychomycosis accounts for one third of fungal skin infections. Because only about one half of nail dystrophies are caused by fungus, the diagnosis should be confirmed by potassium hydroxide preparation, culture or histology before treatment is started. Newer, more effective antifungal agents have made treating onychomycosis easier. Terbinafine and itraconazole are the therapeutic agents of choice. Although the U.S. Food and Drug Administration has not labeled fluconazole for the treatment of onychomycosis, early efficacy data are promising. Continuous oral terbinafine therapy is most effective against dermatophytes, which are responsible for the majority of onychomycosis cases. Intermittent pulse dosing with itraconazole is as safe and effective as short-term continuous therapy but more economical and convenient. With careful monitoring, patients treated with the newer antifungal agents have a good chance of achieving relief from onychomycosis and its complications.     

伊曲康唑联合重组人粒细胞集落刺激因子治疗中性粒细胞减少的血液病患者侵袭性真菌感染的疗效及安全性评价

目的 评价伊曲康唑联合重组人粒细胞集落刺激因子（rhG-CSF）治疗中性粒细胞减少的血液病患者合并侵袭性真菌感染的临床疗效及安全性.方法 回顾性分析2007年1月至2011年12月收治的103例血液病合并真菌感染的患者,治疗期间72例患者出现粒细胞缺乏,其中44例患者应用伊曲康唑联合rhG-CSF治疗（治疗组）,28例患者单独应用伊曲康唑治疗（对照组）.结果 治疗组患者有效率为72.73％,对照组为46.43％（P＜0.05）;中性粒细胞≤500/mm3且≥100/mm3的患者抗真菌治疗有效率明显高于中性粒细胞≤100/mm3的患者（P＜0.05）;粒缺持续时间≤10 d的抗真菌治疗有效率明显低于粒缺持续时间＜10 d的患者（P ＜0.05）;72例患者中确诊9例、临床诊断33例、拟诊30例;确诊组有效率低于临床诊断与拟诊组（P＜0.05）,抢先性治疗组（87.50％）和经验性治疗组（64.00％）的有效率均明显高于目标性治疗组（34.78％）,差异有统计学意义（P均＜0.05）.结论 伊曲康唑联合rhG-CSF治疗中性粒细胞减少的血液病患者真菌感染是有效安全的;中性粒细胞减少的程度和时间是影响真菌治疗效果的重要因素.     

Dermatophyte infections

Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomites. Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy. Diagnosis occasionally requires Wood's lamp examination and fungal culture or histologic examination. Topical therapy is used for most dermatophyte infections. Cure rates are higher and treatment courses are shorter with topical fungicidal allylamines than with fungistatic azoles. Oral therapy is preferred for tinea capitis, tinea barbae, and onychomycosis. Orally administered griseofulvin remains the standard treatment for tinea capitis. Topical treatment of onychomycosis with ciclopirox nail lacquer has a low cure rate. For onychomycosis, "pulse" oral therapy with the newer imidazoles (itraconazole or fluconazole) or allylamines (terbinafine) is considerably less expensive than continuous treatment but has a somewhat lower mycologic cure rate. The diagnosis of onychomycosis should be confirmed by KOH microscopy, culture, or histologic examination before therapy is initiated, because of the expense, duration, and potential adverse effects of treatment.     

Efficacy and safety of itraconazole in the long-term treatment of onychomycosis.

Sixty-one patients with a clinical diagnosis of onychomycosis in finger or toe nails were treated with itraconazole 100 mg/day or griseofulvin 500 mg/day for six to nine months. The infective causes were Trichophyton rubrum, Trichophyton mentagrophytes, or Trichophyton violaceum, and in two cases Candida albicans. A total of 27 finger and 390 toe nails were infected. Statistically significant intragroup reductions from baseline symptom severity values were seen at endpoint (month 6 or 9) for both treatment groups for all parameters: colour change, thickness, brittleness and unaffected area. No clinically or statistically significant differences between the treatment groups were seen at endpoint. However, the itraconazole group continued to improve during the follow-up, while the mean symptom severity ratings remained the same in the griseofulvin group. All itraconazole patients and 85% of griseofulvin patients were rated as cured or markedly improved at endpoint. Nineteen out of 26 evaluable itraconazole patients (73%) remained cured during the three month follow-up period, compared with 12 out of 17 griseofulvin patients (71%). The rather large number of drop-outs, especially among griseofulvin patients, makes it difficult to draw definitive conclusions of the symptom recurrence. Two itraconazole patients stopped medication due to an adverse event, compared to four patients in the griseofulvin group. The clinical laboratory data on itraconazole-treated patients did not show any statistically or clinically significant changes. In conclusion, itraconazole was at least as effective as griseofulvin in the treatment of onychomycosis. The itraconazole group continued to improve after the treatment was stopped. The results show that itraconazole 100 mg/day is safe and efficient in the long-term treatment of fungal nail infections.     

大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜的价值分析

目的探讨大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜的应用价值。方法选择慢性特发性血小板减少性紫癜患者150例,根据随机数字法将患者分为观察组和对照组,观察组患者应用地塞米松40 mg/d,静脉滴注,治疗时间4 d,不再维持治疗。对照组患者每日清晨顿服应用泼尼松l mg/kg,用药时间4周,根据患者血小板水平调整用药剂量。比较两组患者治疗效果及治疗后3 d及5 d血小板水平的变化。结果①观察组患者治疗总反应率为88.00%,对照组患者治疗总反应率为69.33%,观察组患者治疗总反应率显著高于对照组(P<0.05)。②治疗后3 d及5 d,两组患者血小板水平均显著升高,与对照组患者相比,观察组患者血小板改善更加显著(P<0.05)。结论大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜具有较高的应用价值。     

Efinaconazole (Jublia) for the treatment of onychomycosis

Efinaconazole 10% nail solution (Jublia^®) is a new topical triazole antifungal designed for the topical treatment of distal and lateral subungual onychomycosis. It inhibits ergosterol biosynthesis enzyme sterol 14α-demethylase. Efinaconazole has lower minimum inhibitory concentrations than terbinafine, ciclopirox, itraconazole and amorolfine in Trichophyton rubrum, Trichophyton mentagrophytes and Candida albicans. The solution based formula has low surface tension and keratin binding properties that increase penetrance through the nail plate. Safety studies have shown that this formulation is not associated with atopic dermatitis or contact sensitivity. Duplicate Phase III clinical trials in adults with mild to moderate distal and lateral subungual onychomycosis indicate that efinaconazole 10% solution is an effective therapy with a pooled complete cure rate of 17% and a pooled mycological cure rate of 54%. Efinaconazole 10% nail solution is a safe and effective new topical therapy for onychomycosis, which will fill a pressing need for more effective topical therapy in this disease.     

A randomised, double-blind study of itraconazole versus placebo in the treatment and prevention of oral or oesophageal candidosis in patients with HIV infection

HIV-infected patients presenting with oral or oesophageal candidosis were randomised to four weeks treatment with itraconazole 200 mg, followed by itraconazole or matching placebo for a prophylaxis phase of 24 weeks. Clinical and mycological evidence of candidosis infection was assessed on a four-weekly basis. Seventy patients were enrolled, of whom 50 completed 28 days of itraconazole therapy; 74% (37 patients) were clinically cured and 40% were also mycologically cured. Fifteen patients were withdrawn for a variety of reasons including non-compliance, adverse events and the use of excluded medications. Forty-four patients were enrolled in the prophylactic phase. There were significantly more relapses of candidosis, and time to candidosis was significantly shorter in the placebo group than in the itraconazole treated group (p = 0.0001). Itraconazole 200 mg daily is effective and well tolerated for the treatment and prevention of oral and oesophageal candidosis in HIV-infected patients.     

组合维生素干预对脑梗死高同型半胱氨酸血症的临床意义

目的观察叶酸、B族维生素、拜阿司匹灵、立普妥干预对脑梗死高同型半胱氨酸(Hcy)血症患者的临床意义。方法 120例脑梗死高Hcy血症患者随机分为对照组(常规治疗:静点奥扎格雷80mg、舒血宁20ml,1/d;口服拜阿司匹灵0.1,1/d)和观察组(常规治疗+叶酸5mg/d、维生素B6 10mg/d、维生素B12 0.5mg/d、立普妥20mg/d),每组60例。治疗前及治疗后半年检测血浆Hcy浓度和颈动脉彩超;行神经功能缺损评分(NIHSS),观察脑梗死复发率。结果治疗前两组Hcy水平均增高(P>0.01);与对照组比较,半年后观察组Hcy水平明显降低、颈动脉软斑面积明显缩小(P<0.01);观察组NIHSS、脑梗死复发率均显著降低(P<0.01)。结论脑梗死高Hcy血症患者经维生素类联合干预治疗可降低Hcy水平,缩小、稳定颈动脉斑块,改善NIHSS评分、降低脑梗死远期复发率。     

Terbinafine versus itraconazole and fluconazole in the treatment of Vulvovaginal candidiasis

Vulvovaginal candidiasis is one of the most frequent infections of the female genital tract with a high incidence. Although numerous antimycotical agents are available for treatment of yeast vaginitis, there are few comparative data on the in vivo and in vitro activity of these drugs. The aim of this open, randomized, and comparative study was to determine in vivo and in vitro effectiveness of the 3 systemic antifungal agents: terbinafine and 2 azoles (itraconazole and fluconazole) in the treatment of patients with Vulvovaginal candidiasis. A total of 44 patients who had signs and symptoms of Vulvovaginal candidiasis were recruited for the study. Patients were randomly assigned to 3 groups: terbinafine 500 mg/d orally was used for 7 days, itraconazole 200 mg/d orally was used for 7 days, and fluconazole 150 mg orally was used as a single dose. Both clinical and mycologic examinations were performed for posttreatment assessment at week 4. This study revealed a clinical cure rate 33.3% for terbinafine, 60% for itraconazole, and 66.6% for fluconazole (P>0.05). Mycologic cure rates were 33.3%, 10%, and 66.6% respectively (P<0.05). Overall cure rates were 33.3%, 10%, and 53.3% (P>0.05). Terbinafine could be an alternative treatment option in Vulvovaginal candidiasis because there were no significant differences in the clinical and overall cure rates among 3 antifungal agents. However, terbinafine could not be suggested as a first-line treatment in Vulvovaginal candidiasis. Systemic use of terbinafine in larger numbers of cases may give more information about the effectiveness of this drug in the treatment of patients with vulvovaginal candidiasis.     

蓝光照射对于新生儿高胆红素血症的临床疗效

目的探讨蓝光照射对于新生儿高胆红素血症患者的治疗效果,评价其临床价值。方法对于2010年12月至2011年12月治疗的64例新生儿高胆红素血症患者,随机分为两组,对照组患者给予苯巴比妥,观察组患者给予蓝光照射治疗（A组给予持续性蓝光照射,B组给予间歇性蓝光照射）,对两组患者的有效率、退黄效果、胆红素下降程度及疗程进行比较。结果观察组患者治疗有效率为90．6％（29／32）,对照组患者治疗有效率为71．8％（23／32）,观察组有效率高于对照组（P〈0．05）;观察组患者的胆红素下降速度快于对照组,黄疸减退时间均短于对照组（P〈0．05）;观察组患者的疗程短于对照组,间歇性照射效果好于持续照射,两组间差异具有统计学意义（P〈0．05）。结论蓝光治疗对于新生儿高胆红素血症患者的治疗效果较好,能够提高患者的有效率,促进胆红素下降及黄疸消退,间歇性蓝光照射效果好于持续性照射,具有很好的临床应用价值。