甲真菌病组织病理学及真菌学研究

目的：提高甲真菌病的诊断率，弥补真菌学检查的不足。方法：采用30％硝酸水溶液浸泡病甲标本3～7d的改良组织病理学方法。结果：组织病理切片的甲真菌病诊断率为86％，真菌培养为58％，直接镜检为68％。结论：此方法简便易行，患者易接受，组织清理切片的甲真菌病诊断率明显高于真菌学的方法，值得推广使用。     

甲真菌病组织病理学及真菌学研究

目的：提高甲真菌病的诊断率、弥补真菌学检查的不足。方法：采用３０％硝酸水溶液浸泡病甲标椟３－７ｄ的改良组织病理学方法。结果：Ｘ两全是切的甲真菌病诊断率为８６％，真菌培养为５８％，直接镜检为６８％。结论：此方法简便易行，患者易接受，组织病理切片的甲真菌病诊断率明显高于真菌学的方法，值得推广使用。     

甲真菌病临床诊断与真菌学检查结果的差异性

目的：了解临床医生仅凭临床表现判断甲真菌病的准确率及其与真菌镜检和培养结果之间的符合情况。方法随机选择2014年3月至2015年11月到我院皮肤科门诊就诊，由我科主治医师及以上职称的医师拟诊为甲真菌病的395例患者，取甲碎屑行真菌镜检和培养，计算仅凭临床表现诊断的甲真菌病与真菌学检查的符合情况。结果临床诊断和真菌镜检结果的符合率为63.80%，临床诊断和真菌培养结果的符合率为38.73%，真菌镜检和真菌培养结果同时阳性的概率为55.56%，甲真菌病真菌镜检检出率比真菌培养高(χ2=82.99，P<0.01)，Kappa检验提示真菌镜检与培养的一致性一般(Kappa=0.404，P<0.01)。结论仅凭临床表现诊断甲真菌病准确率不高，真菌镜检的检出率比真菌培养高。     

371例甲真菌病致病真菌菌种分析

目的 通过对371例甲真菌 病的调查,探讨致病真菌菌种构成及防治方法。方法 靶甲进行10％KOH镜检、沙保氏琼脂培养基培养、组织病理检查和AMS分析等研究。结果 真菌镜检发现310例阳性（83.6%),真菌培养阳性296例（79.8%)。共有305株致病菌株。其中酵母菌115例（38.8%),皮肤病癣菌123例（41.6%),霉菌49例（16.5%),混合真菌感染9例（3.0%)。结论 甲真菌病的致病仍以皮肤癣菌为主,近年来酵母菌和混合真菌感染有明显上升趋势。     

江门地区老年甲真菌病及易感因素流行病学分析

目的 探讨江门地区老年甲真菌病的致病真菌分布与临床类型的特点.方法 对107例具有甲真菌病学典型临床表现并经病甲屑镜检阳性的老年患者进行真菌培养,对靶病甲进行临床形态学分型,填写调查问卷调查易感因素.结果 121例靶病甲培养的病原菌分别为皮肤癣菌71.07％、酵母菌25.62％、霉菌3.31％；临床类型为全甲毁损型48.76％、远端侧位甲下型24.79％、近端甲下型19.01％、白色浅表型7.44％；107例问卷调查示糖尿病患者15例(14.02％).结论 江门地区老年甲真菌病致病菌主要为皮肤癣菌,临床类型以全甲毁损型为主,红色毛癣菌为其优势菌；糖尿病为其主要易感因素.     

伊曲康唑短程间歇冲击疗法治疗甲真菌病

伊曲康唑短程间歇冲击疗法治疗甲真菌病３３例。服药后第１３周、停药后３个月、６个月其临床治疗率分别是１５．１％、６０．６％、９０．９％；真菌镜检转阴率分别为５６．６％、８２．８％、９６．３％。其临床治愈率，真菌镜检阴率经统计学处理均有非常显著性差异（Ｐ〈０．０１）。提示伊曲康唑治疗甲真菌病具有起效快，治愈率高等优点。     

甲真菌病的3种实验诊断方法研究

目的：探索一种操作简便、结果可靠的甲真菌病检验方法。方法：对121例拟诊甲真菌病的患者分别采用KOH直接镜检法和浸软法进行病损指、趾甲的真菌镜检,并与真菌培养法进行比较。结果：直接镜检法检出58例（47.90%）,20% KOH溶甲法检出118例（97.52%）,真菌培养法检出72例（59.50%）。结论：20% KOH浸软法真菌镜检是一种适合临床的、检出率高、可行性强的甲真菌病诊断方法。     

409例甲真菌病病原菌分离培养

甲真菌病可以由皮肤癣菌、酵母菌和霉菌引起。为了解甲真菌病的病原菌分布情况,１９９５年１月至１９９８年７月,我科对４０９例甲真菌病患者进行病原菌的分离培养,现将结果报道如下。１资料和方法１．１病例选择：４０９例均为我科门诊的甲真菌病患者,真菌直接镜检及...     

220例甲真菌病真菌培养分析

目的了解220甲真菌病真菌培养结果.方法刮取病甲部位的甲屑直接涂片镜检做初步诊断,用斜面培养和小培养鉴定真菌种类.结果220例甲真菌病患者真菌培养共165例阳性,培养阳性率75%,分离出病原菌172株,其中皮肤癣菌81株,占47.09%,酵母菌72株,41.86%,霉菌19株,占11.04%,混合感染7例,占4.06%.结论甲真菌病的感染主要是由皮肤癣菌、酵母菌、霉菌,皮肤癣菌中以红色癣菌所占比例最多.     

特比萘芬与伊曲康唑治疗真菌病临床疗效与安全性评价

目的 比较特比萘芬片和伊曲康唑胶囊治疗甲真菌病的疗效和安全性。方法 甲真菌病病例227例。真菌学检查用KOH直接镜检及真菌培养。随机对2组病例中的79例患者在治疗前及治疗后进行血、尿常、血生化检查。特比萘芬组86例(男30例，女56例)，特比萘芬片(兰美抒)WK1 250mg，每日1片121服，WK2—8(指病甲)或WK2—12(趾病甲)250mg，隔日1片口服。伊曲康唑组141例(男48例，女93例)，伊曲康唑胶囊200mg，每日二次口服，连服1WK，停药3WK为一疗程。指病甲2个疗程，趾病甲或指、趾病甲3个疗程。结果 特萘芬与伊曲康唑治疗甲真菌病临床疗效比较，总有效率分别为92％和90％，P＞0．05，均无显著性差异。2组的血、尿常规、血生化检查，结果均在正常范围内。不良反应分别为8％和3％。复发率分别为5．8％和2％。结论特比萘芬的连续疗法及伊曲康唑的冲击疗法是可行的。均具有较高的临床疗效和真菌学痊愈率，且具副作用小、耐受性好、安全性高等优点。     

Utility of histopathologic analysis in the evaluation of onychomycosis

Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before initiation of antifungal therapy. Potassium hydroxide preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent studies have suggested that nail plate biopsy with periodic acid-Schiff stain may be a very sensitive technique for the diagnosis of onychomycosis. In this article, we review the literature on the utility of histopathologic analysis in the evaluation of onychomycosis. Many of these studies indicate that biopsy with periodic acid-Schiff is the most sensitive method for diagnosing onychomycosis. We propose that histopathologic examination is indicated if the results of other methods are negative and clinical suspicion is high; therefore, it is a useful complementary technique in the diagnosis of onychomycosis.     

佛山地区甲真菌病感染情况的调查研究

目的研究佛山地区甲真菌病感染情况、菌种类型以及所占比例.方法收集2010 年8 月至2011年8 月到本院皮肤科就诊的657 例甲病患者标本,同时对标本进行真菌学检查、培养及鉴定.结果657 例甲病患者中真菌培养阴性426 例,阳性231 例,阳性率35.2%.阳性菌中酵母菌124 例占53.7%,其中白色念珠菌、近平滑念珠菌、热带念珠菌分别占25.1%、13.9%、8.7%;皮肤癣菌占41.1%,其中红色毛癣菌、须癣毛癣菌所占比例分别为23.8%、13.4%;霉菌所占比例为5.2%,以曲霉菌和青霉菌为主,分别占3.5%和1.3%,不排除污染.结论佛山地区甲真菌病主要致病菌为酵母菌、其次为皮肤癣菌和霉菌,菌种以白色念珠菌、红色毛癣菌、近平滑念珠菌、须癣毛癣菌和热带念珠菌最多见.     

伊曲康唑冲击疗法治疗甲真菌病50例

目的： 评价伊曲康唑冲击疗法治疗由皮肤癣菌、酵母菌和霉菌引起的甲真菌病的有效性、安全性和耐受性。方法： 采用冲击疗法, 连续服用伊曲康唑（４００ ｍｇ／ｄ） １ 周后, 停药３周为１ 个疗程。指甲真菌病服药２ 个疗程; 趾甲真菌病服药３ 个疗程。观察疗程结束、停药３个月及停药６ 个月时指（ 趾） 甲真菌病的临床治愈率和真菌学治愈率。结果： 疗程结束时、停药后３ 个月及停药后６ 个月时指甲真菌病的临床治愈率分别为２５ ％ 、８５ ％ 和９０ ％ , 真菌学治愈率分别为６５ ％ 、９０ ％ 和９５ ％ ; 趾甲真菌病的临床治愈率分别为１６－６ ％ 、６３－３ ％ 和８６－７ ％ , 真菌学治愈率分别为５６－７ ％ 、８３－３ ％ 和９０ ％ 。疗程结束后, 随时间延长治愈率不断提高, 停药后６ 个月达最高。指甲真菌病的治愈率高于趾甲真菌病; 真菌学治愈率高于临床治愈率。未发现严重不良反应。停药后６ 个月时复发率为６ ％ 。结论： 伊曲康唑为广谱抗真菌药, 冲击疗法治疗甲真菌病具有疗效高、安全性好、耐受性高以及费用低廉的特点。     

Intermittent-pulse treatment of onychomycosis with orally administered itraconazole]

Fifty-four patients received an intermittent regimen of itraconazole (26 of them were finger onychomycosis and 28 toe onychomycosis) and were followed-up for nine months. The result showed that the clinical cure rate of fingernails was 88.5% and the mycologic cure rate was 96.4%, while the clinical cure rate of toes was 82.1% and the mycologic cure rate was 96.4%. Few adverse events were observed by 7.4%, just like nausea, gastric discomfort etc. It suggests that the pulse administration system is highly effective and has a few side-effects.     

武汉地区1994～1997年甲真菌病病原菌的变迁

调查近４年武汉地区甲真菌病病原菌的变化情况。结果显示皮肤癣菌占６６．５％（其中以红色毛癣菌多见）、酵母菌３２．１％（念珠菌属多见）、霉样菌１．４％。酵母菌有增多趋势,近两年甲真菌病中酵母菌阳性率明显高于前两年（均为Ｐ＜０．０５）。酵母菌感染指甲的百分率明显高于趾甲     

伊曲康唑间歇冲击疗法治疗甲真菌病

用伊曲康唑短程间歇冲击疗法治疗甲真菌病５４例（指甲真菌病２６例,趾甲真菌病２８例）,并随访９个月。结果显示：患者指甲临床治愈率为８８５％,真菌学治愈率为９６１％;趾甲临床治愈率为８２１％,真菌学治愈率为９６１％;仅有７４％的患者出现恶心、胃肠道不适等轻微副作用。本疗法疗效高、副作用小和安全性好     

Confirmation of dermatophytes in nail specimens using in-office dermatophyte test medium cultures. Insights from a multispecialty survey

Using data from a multicenter nationwide multispecialty survey, the authors investigated the efficacy of in-office dermatophyte test medium (DTM) and central laboratory cultures used to confirm onychomycosis across samples collected by podiatric, dermatologic, and primary-care physicians. The samples collected by podiatric physicians were both positive or both negative in 43% and 27% of patients, respectively. Samples harvested by dermatologists were both positive in 37% of patients and both negative in 32%, while the samples collected by primary-care physicians were both positive in 28% of patients and both negative in 38%. The accuracy of DTM and central laboratory tests is dependent on the proper collection of nail samples, and the accuracy of mycologic test results varied significantly across nail specimens harvested by podiatric, dermatologic, and primary-care physicians. DTM culture was found to be an effective and convenient method of confirming dermatophyte infections in patients with signs of onychomycosis. The data presented here indicate that the special expertise of podiatric physicians in treating foot-related illnesses translates into more accurate mycologic testing.     

The value of cytologic brushing with the aid of fiberoptic colonoscopy in the diagnosis of carcinoma of colon

Preoperative cytologic brushing and biopsy under direct Vision withfiberoptic colonoscopy(FC)and postoperative histopathologic examination wereperformed in 147 patients who were suspected of suffering from carcinoma of co-lon.In FC cytologic brushing,128 cases were positive for malignancy(87.1percent),18 false-negative(12.2 percent)and only one false-positive(0.7 percent).In the 146 FC biopsy specimens,124 were positive for malignancy(84 4 percent)and 22 false-negative and no false-positive.Combination of FC cytologic brushingwith FC biopsy could raise the diagnostic rate of colonic carcinoma to 95.2% anddecrease false-negative and false-positive because the two methods may replenisheach other in sampling and observation.Cytologic brushing is most valuable tothe early diagnosis of colonic carcinoma.When colonic stricture and obstructionprevent the colonoscope from reaching the lesion and FC biopsy cannot bedone,FC cytologic brushing is an effective method for diagnosis.The positiverate and false-negative rate of the cytologic brushing did not correlate to grosstyping,histopathologic typing and Dukes staging(P>0.05).The factorsinfluencing the correct diagnosis of colonic carcinoma by FC cytologic brushingare discussed in this paper.     

Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis

Background  Recent research shows that lasers can inhibit fungal growth and that Nd:YAG 1064-nm lasers can penetrate as deep as the lower nail plate. The aim of this study was to observe the effect of a long-pulse Nd:YAG 1064-nm laser on 154 nails of 33 patients with clinically and mycologically proven onychomycosis.

Methods  Thirty-three patients with 154 nails affected by onychomycosis were randomly assigned to two groups, with the 154 nails divided into three sub-groups (II degree, III degree, and IV degree) according to the Scoring Clinical Index of Onychomycosis. The 15 patients (78 nails) in group 1 were given eight sessions with a one-week interval, and the 18 patients (76 nails) in group 2 were given four sessions with a one-week interval.

Results  In group 1, the effective rates at 8 weeks, 16 weeks, and 24 weeks were 63%, 62%, and 51%, respectively, and the effective rates in group 2 were 68%, 67%, and 53% respectively. The treatment effect was not significantly different between any sub-group pair (P >0.05).

Conclusions  Long pulse Nd:YAG 1064-nm laser was effective for onychomycosis. It is a simple and effective method without significant complications or side effects and is expected to become an alternative or replacement therapy for onychomycosis.