伊曲康唑间隙冲击疗法治疗甲真菌病200例

目的 :观察伊曲康唑冲击疗法治疗甲真菌病的临床疗效。方法 :2 0 0例甲真菌病患者每天口服伊曲康唑胶囊 2次 ,每次 2 0 0mg× 7天 ,停药 2 1天为 1个疗程。指甲真菌病用药 2个疗程 ,趾甲真菌病及指趾甲真菌病用药 3个疗程。结果 82例指甲真菌病临床痊愈率 91 4 6 % ,118例趾甲真菌病及指趾甲同患真菌病临床痊愈率 81 36 % ,二者伴发皮肤真菌感染者真菌清除率分别为 98 5 %和 97%。结论 :伊曲康唑短期冲击疗法治疗甲真菌病疗程短、疗效高、副作用小、安全性高、复发率低。     

中等剂量伊曲康唑间歇冲击治疗甲真菌病

我们于1996年5月至1997年7月,在甲病专科门诊中,应用西安杨森制药有限公司生产的伊曲康唑治疗甲真菌病93例,并在停止治疗用药8个月后,进行临床疗效追踪随访,现将结果总结如下。一、临床资料在甲病专科门诊中,经临床确诊为甲真菌病患者93例,男35例,女58例;年龄16～68岁。指甲真菌病28例,趾甲真菌病10例,指(趾)甲同时感染者55例。受累指甲118个,受累趾甲331个。二、服药方法及疗效观察每天服药200ｍｇ,分别于餐中或餐后即服100ｍｇ,每月连续服药75天(每盒15片)为一疗程,休息3周后继续下一疗程。每例患者选择一个受累最重的甲为靶甲,按受累指(…     

伊曲康唑和特比萘芬序贯疗法治疗甲真菌病的临床观察

目的:探讨序贯疗法治疗甲真菌病的安全性、依从性和疗效.方法:甲真菌病患者先服伊曲康唑1周,停3周为1个疗程,接着服特比萘芬1周,停3周为1个疗程.指甲真菌病服2个疗程,趾甲真菌病服3个疗程.结果:指甲真菌病有效率100%,趾甲真菌病有效率90.91%.结论:伊曲康唑与特比萘序贯疗法治疗甲真菌病安全有效,依从性好.     

伊曲康唑短程间歇冲击疗法治疗甲真菌病

根据伊曲康唑口服后药物动力学的研究结果 ,采用短程间歇冲击疗法治疗甲真菌病 5 6例 ,对其中完成服药疗程并随访6个月以上的 33例总结如下。临床资料与方法　一般资料 :甲真菌病患者 33例大部分来自门诊 ,少数来自住院病人。有典型的指趾甲病变 ,真菌镜检全部阳性。男 15例 ,女 18例 ,年龄 2 0～ 70岁 ,平均 37.7岁 ;病程最短 4个月 ,最长 2 0年 ,平均 10 .12年 ;病例中病甲数 1～ 19个不等。 33例共有病甲 373个 ,平均每例11.3个 ,其中 3例指甲真菌病 ,病甲 13个 ,6例趾甲真菌病 ,病甲 41个 ,2 5个指趾甲并患 ,病甲 319个。服药方法和疗程…     

伊曲康唑间隙冲击疗法治疗甲真菌病疗效观察

自 1997年 7月至 1998年 8月 ,我们用广谱抗真菌药物伊曲康唑 (商品名斯皮仁诺 )治疗指 (趾 )甲真菌病 18例 ,取得满意效果 ,现报告如下 :1　病例选择 　18例病人全部为我院门诊及住院患者 ,其中女 10例 ,男 8例 ;年龄 15～ 6 0岁 ,平均 37 5岁 ,指甲真菌病 10例 ,受累指甲总数 6 8个 ;趾甲真菌病 3例 ,受累趾甲16个 ;指趾甲真菌病 5例 ,受累指、趾甲 2 6个。病程最长30年 ,最短 4个月。 18例甲病中 ,合并手足癣 12例 ,股癣 2例 ,并发癣菌疹 1例 ,治疗前全部病人甲真菌直接镜检阳性。2　给药方法及疗效评价标准2 1　每日服用伊曲康唑 40 0…     

国产特比萘芬治疗甲真菌病40例疗效观察

目的:观察国产特比萘芬治疗甲真菌病的疗效;方法:将门诊确诊为甲真菌病的患者分为治疗组40例(口服特比萘芬)和对照组36例(口服伊曲康唑);结果:停药6个月后治疗组的指趾甲真菌病治愈率分别是84.1%和83.5%;有效率分别是98.4%和95.9%;对照组指趾甲真菌治愈率分别90.9%和88.3%,有效率分别为99.0%和97.9%,两组指趾甲真菌病治愈率比较差异无显著性(指甲2=2.19,趾甲2=1.67,均P>0.05);结论:国产特比萘芬治疗甲真菌病有较好疗效。     

伊曲康唑间歇冲击疗法治疗甲真菌病疗效观察

自1994年7月～1995年8月,我们应用西安杨森公司生产的伊曲康唑治疗甲真菌病20例,取得良好疗效,现报告如下。临床资料　20例中男2例,女18例,年龄23～59岁,平均37.6岁。病程8月～10年,平均5.07年。临床表现典型,真菌镜检阳性。无严重肝、肾、心肺疾患。3个月内未接受过全身抗真菌治疗。共有病甲119个,其中指甲57个,趾甲62个。单患指甲真菌病8例,趾甲真菌病4例,同患指趾甲真菌病8例。个例病甲数最少2个,最多14个。真菌镜检20例全部阳性,真菌培养15例阳性,其中红色毛癣菌12例,石膏样毛癣菌2例,念珠菌1例。服药方法及疗效观察　采用间歇冲击疗法,…     

特比萘芬合用地巴唑治疗甲真菌病的随机双盲对照研究

目的 观察特比萘芬与地巴唑联合治疗甲真菌病的疗效。方法 甲真菌病患者随机分组,治疗组口服特比萘芬250mg每日1次,同时口服地巴唑10mg每日3次;对照组口服特比萘芬250mg每日1次,同时口服安慰剂。治疗组指甲真菌病疗程为6周,趾甲疗程为8周;对照组指甲真菌病疗程为8周,趾甲疗程为10周。观察2种方法的疗效。结果 治疗后第24周随访,治疗组54例痊愈率为70.4%(38/54例),有效率为83.3%(45/54例);对照组51例痊愈率为66.7%(34/51例),有效率为80.4%(41/51例),两组比较差异均无显著性(P>0.05)。结论 特比萘芬与血管扩张剂联合治疗甲真80.4%(41/51例),两组比较差异均无显著菌病能缩短疗程,且无明显不良反应。     

伊曲康唑和特比萘芬序贯法治疗甲真菌病疗效观察

目的观察伊曲康唑和特比萘芬序贯疗法治疗甲真菌病的临床疗效及安全性。方法对照组采用伊曲康唑冲击治疗(每日中晚餐各口服伊曲康唑200mg,连用1周,停用3周为一个疗程),指甲真菌病治疗2个疗程,趾甲真菌病治疗3个疗程。观察组指甲真菌病先用伊曲康唑冲击治疗1个疗程,随后应用盐酸特比萘芬冲击疗法(每日中晚餐各口服特比萘芬250mg,连用1周,停药3周),趾甲真菌病还需再重复伊曲康唑冲击治疗1个疗程。两组治疗结束后3、6月时各复诊一次,观察不良反应发生情况。结果观察组治疗3个月后的有效率显著高于对照组(P0.05),经6个月治疗后,2组有效率与治疗3个月后有效率相比均略有提高,但差异无统计学意义(P0.05),观察组有效率高于对照组,但无显著性差异(P0.05)。复发率观察显著低于对照组(P0.05)。结论伊曲康唑和特比萘芬序贯疗法治疗甲真菌病疗效确切,复发率与不良反应较少,值得临床推广应用。     

影响甲真菌病疗效的因素

我科甲真菌病门诊1994年7月至1999年6月用伊曲康唑治疗该病共545例,均完成疗程和随访,且资料完整,指甲真菌病痊愈率达83.14%,趾甲真菌病达79.23%.同时我们也发现了以下现象:①治疗后长出的新甲,有的长到某一长度后就停止了,即使继续服药也不再延长;②治疗后病甲范围缩小或已痊愈,但一停药又渐渐扩大或重新出现病甲;③治疗前病甲色深而厚者治疗后真菌培养转阴,但有的新甲仍稍厚或有纵嵴或有纵条状色素沉着或甲脆无光泽,需再经6～9个月后才完全正常;④在追踪随访中发现复发或再感染等.为了探讨产生这些现象的原因,以提高甲真菌病的疗效,现就伊曲康唑口服治疗545例的结果,对影响甲真菌病疗效的因素初步分析如下.     

Fifth toenail clinical response to systemic antifungal therapy is not a marker of successful therapy for other toenails with onychomycosis

BACKGROUND: Onychodystrophy is a major manifestation of onychomycosis. However, nail trauma may also result in onychodystrophy. The fifth toenail, due to its location, suffers repeated friction/pressure trauma from shoes. OBJECTIVE: To test the hypothesis that treatment failure of fifth toenail onychomycosis is not a marker of treatment failure of other toenails with onychomycosis. METHODS: Fifty patients who had fifth toenail deformity (with or without onychomycosis) and onychomycosis of the other toenails were treated with oral terbinafine, 250 mg/day, for 4 months. RESULTS: Forty-three patients completed the study. Before the study, 26/43 (61%) had callus lateral to the fifth toe (suggesting mechanical pressure in that area). Twenty-one/43 (49%) of the fifth toenails had onychomycosis. At the end of the treatment period, only 4/21 (19%) of the fifth toenails (with initial onychomycosis), compared with 12/21 (57%) of the other toenails, were completely cured (CC). Out of the whole group (n=43), the clinical cure rate of the fifth toenail was 4/43 (9%) and for the other toenails, 20/43 (47%) (P<0.05). The mycological cure rates were 11/21 (52%) for the fifth toenail and 25/43 (58%) for the other toenails. Callus lateral to the fifth toe was associated with a poor clinical result (P<0.01). CONCLUSIONS: Clinical improvement of the fifth toenail after systemic antifungal therapy is less favourable and does not correspond with the clinical cure of the other toenails, mostly because of mechanical factors. Therefore, patients should be told to adjust their expectations as to the visual results of their antifungal treatment.     

Distal and lateral toenail onychomycosis caused by Trichophyton rubrum: treatment with photodynamic therapy based on methylene blue dye

The study showed the effectiveness of photodynamic therapy based on methylene blue to treat severe distal and lateral subungual toenail onychomycosis. 22 patients were divided into two groups: group A consisting of 11 patients with severe toenail onychomycosis and group B consisting of 11 patients with mild-to-moderate toenail onychomycosis. All patients had onychomycosis caused by Trichophyton rubrum. The patients were treated with sessions of 2% methylene blue aqueous solution irradiated with light emission diode device with 630 nm and 36 J/cm2 biweekly for six months. The clinical response was significantly better in patients with mild-to-moderate (100%) onychomycosis compared with patients with severe onychomycosis (63.6%).     

Terbinafine (Lamisil) treatment of toenail onychomycosis in patients with insulin-dependent and non-insulin-dependent diabetes mellitus: a multicentre trial

BACKGROUND: Diabetes mellitus (DM) affects an estimated 175 million people world-wide. Approximately one-third of patients with DM have toenail onychomycosis. OBJECTIVES: To determine the efficacy and safety of terbinafine treatment of toenail onychomycosis in patients with DM receiving insulin and/or oral antidiabetic agents. Special interest was focused on potential drug interactions with oral hypoglycaemic substances. METHODS: In a multicentre trial, patients suffering from insulin-dependent DM (IDDM) or non- insulin-dependent DM (NIDDM) with toenail onychomycosis were treated for 12 weeks with oral terbinafine 250 mg daily and followed up to 48 weeks. In addition to clinical, mycological and laboratory investigations, blood glucose levels were monitored. RESULTS: At the end of the trial (week 48), a mycological cure rate of 73% was achieved. The rates of clinical cure and complete cure (mycological cure plus clinical cure) were 57% and 48%, respectively. There was no statistically significant difference between the NIDDM and IDDM groups with respect to the cure rates (P > 0.05). No hypoglycaemic episode was reported and none of the patients had hypoglycaemia during the treatment phase. CONCLUSIONS: With excellent cure rates and a good tolerability profile, terbinafine should continue to be a drug of choice for the treatment of toenail onychomycosis in the rising number of NIDDM patients receiving multiple medication.     

伊曲康唑间歇冲击治疗趾甲真菌病疗效和血清及甲中药物水平临床研究

目的:研究伊曲康唑间歇冲击疗法治疗趾甲真菌病(甲母质未受累)的疗效和在血清及甲中药物水平的变化。方法:41例趾甲真菌病患者应用伊曲康唑连续3个冲击治疗,第52周进行最终疗效评价;采用高压液相色谱仪(HPLC)法对其中15例趾甲真菌病患者进行了血清及甲中药物测定。结果:每次冲击后4周,血清中均未测得伊曲康唑;甲组织中伊曲康唑水平较高,在8或12周时达到高峰,停药后,伊曲康唑仍能以较高的水平在甲中储留36周;同一时间点,指甲和趾甲中的药物水平相似(P>0.05)。在第52周时,趾甲真菌病的临床治愈率为66.7％,临床有效率为79.5％,真菌学清除率为64.1％。结论:伊曲康唑口服吸收后从血液迅速向甲组织分布,停药后仍以较高水平储留在甲组织中并持续存在36周以上。     

特比萘芬治疗糖尿病患者甲真菌病疗效和对血糖水平的影响

目的:评价特比萘芬连续疗法治疗糖尿病患者甲真菌病的有效性、安全性、耐受性和对患者血糖水平的影响。方法:90例糖尿病甲真菌病患者口服特比萘芬250mg,每日1次,指甲癣患者连续口服12周,趾甲癣患者连续口服16周;停药第24周观察最终疗效和血糖水平。结果:在第36周时,指甲真菌病的临床治愈率84.8%,有效率90.9%,真菌学治愈率93.9%;第40周时,趾甲真菌病的临床治愈率78.9%,有效率87.7%,真菌学治愈率89.5%;治疗前后空腹血糖和糖化血红蛋白水平无显著性差异。结论:特比萘芬治疗糖尿病患者甲真菌病有效、安全,耐受性良好;对患者血糖水平无明显影响。     

Is slow nail growth a risk factor for onychomycosis?

This study was carried out to determine whether slow nail growth is a predisposing factor for onychomycosis or if onychomycosis results in slow nail growth. Forty-nine patients with unilateral onychomycosis of the great toenail were enrolled and classified in two groups according to the size of affected area, i.e. more than half or less than half of the toenail. The growth rates of affected and unaffected great toenails of all patients were measured. Before a normal appearance was reached, the growth rates of affected great toenails, when the affected area occupied more than half of total nail plate, was slower than that of the unaffected great toenails. After a normal appearance was achieved, there were no differences in growth rates between affected and unaffected great toenails. Therefore, this study of patients with unilateral toenail onychomycosis did not support the hypothesis that slow nail growth rate is a predisposing factor for onychomycosis.     

Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients

OBJECTIVE: To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis. DESIGN: Prospective study based on a specially designed questionnaire completed by dermatologists. PATIENTS: A total of 2761 patients with toenail onychomycosis. MAIN OUTCOME MEASURES: The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture. RESULTS: In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus. CONCLUSIONS: The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.     

糖尿病患者趾甲真菌病的患病率及易感因素

目的 探讨糖尿病患者甲真菌病的患病率及易感因素.方法 研究我院糖尿病门诊和住院的糖尿病患者趾甲真菌病的发病情况,并与非糖尿病组比较.结果 糖尿病组与对照组趾甲真菌病的患病率分别为20.8%和9.4%,两组差异有显著性(P<0.001).两组均发现趾甲真菌病的患病率和年龄、性别显著相关(P<0.001).糖尿病组皮肤癣菌和酵母菌分离率接近,分别为47.4%和40.0%,对照组则为66.6%和27.3%.单因素分析表明趾甲真菌病的易感因素包括:糖尿病病程、周围血循环障碍、末梢神经炎、视网膜病变及口服免疫抑制剂.结论 糖尿病人群合并趾甲真菌病的风险是对照组的2.2倍.易感因素包括老龄、男性、病程长、周围血循环障碍、末梢神经炎、视网膜病变及口服免疫抑制剂.     

Pilot study to evaluate a plasma device for the treatment of onychomycosis

Onychomycosis is a fungal infection of the nail unit, and is the most common of the nail disorders. Current therapies for onychomycosis have less than ideal efficacy and have the potential for adverse effects. As previous studies have shown that nonthermal plasma inhibits the in vitro growth of Trichophyton rubrum, we conducted a pilot study on 19 participants with toenail onychomycosis. The primary endpoint was safety of the device, and secondary outcome measures were clinical efficacy and mycological cure. Patient satisfaction was measured using questionnaires at the completion of the study. All but one patient met the primary endpoint of safety and there were no long‐term sequelae. The overall clinical cure was 53.8% and the mycological cure was 15.4%. The majority of patients were satisfied with the treatment. Our conclusions are that nonthermal plasma is a safe treatment and may have a beneficial effect on toenail onychomycosis.