外阴阴道念珠菌病的危险因素分析

目的 探讨外阴阴道念珠菌病发病的危险因素.方法 使用专门设计的《外阴阴道念珠菌病的流行病学调查表》在3个研究中心调查156例外阴阴道念珠菌病患者和112名健康女性对照者,并通过单因素分析和多因素Logistic分析外阴阴道念珠菌病的危险因素.结果 单因素统计分析结果 提示:性伴患生殖器念珠菌病、经期性生活、合并其他性传播疾病、合并妊娠、口服避孕药、洗盆浴、心情抑郁、穿紧身裤、人工流产史为其危险因素.多因素Logistic分析结果 显示:性伴患生殖器念珠菌病、人工流产史、经期性生活、口服避孕药、合并其他性传播疾病、性伴不固定、使用宫内节育器、已婚、使用抗生素为本病的危险因素.结论 性伴患生殖器念珠菌病、人工流产史、经期性生活、口服避孕药、合并其他性传播疾病、性伴不固定是外阴阴道念珠菌病发病的主要危险因素(OR=2.01～9.77).     

系统性白念珠菌病患者血清中芽管抗体的检测

目的 探讨一种诊断深部白念珠菌病的新方法.方法 以间接免疫荧光法测定白念珠菌系统感染患者血清中芽管抗体的滴度,并与常规真菌检测结果及菌株磷脂酶活性相比较.结果 血清中芽管抗体检测与常规检测方法(镜检+培养)阳性率比较,有较好的一致性(P<0.001).磷脂酶活性测定结果显示,感染组患者分离株较定植组的磷脂酶活力差异有统计学意义(P<0.05);磷脂酶活性与芽管抗体滴度具有相关性,P<0.001.结论 检测白念珠菌芽管抗体在系统件白念珠菌感染诊断中具有一定的诊断意义.     

皮肤念珠菌病患者多部位分离菌株DNA分型研究

目的 比较皮肤念珠菌病患者不同部位分离菌株基因相似性,推测皮肤念珠菌病多部位感染的可能途径。方法 采用PCR扩增引物P-Ⅰ和P-Ⅱ扩增出白念珠菌染色体25SrDNA片段和特征性的基因片段重复序列片段,结合两种扩增结果进行分型,并将870bp大小的特征性的基因片段重复序列片段用限制性内切酶EcoRⅠ和ClaⅠ消化。结果 来自19例皮肤念珠菌病患者的41株白念珠菌被分为6型,同一患者不同部位分离菌株基因型相似,不同个体间基因型有差异。结论 分离自皮肤念珠菌病患者不同部位的致病菌株基因型相同,提示其发病可能与外源性再发感染无关。     

外阴阴道念珠菌病患者临床分离菌株的菌种及基因型分析

目的 探讨初发型、复发型外阴阴道念珠菌病患者及健康带菌者阴道分离的念珠菌菌种及菌株基因型与初发及复发的关系。方法 选择分别来自健康带菌者、外阴阴道念珠菌病患者和复发性外阴阴道念珠菌病患者。首先经菌种鉴定,然后用RAPD技术对来自3组人群的菌株进行基因分型。结果 临床分离株菌种鉴定结果为白念珠菌83株,非白念珠菌共14株。从9个随机引物中筛选出的2条引物(引物4和引物7)对初发组、复发组及健康带菌组分离株的扩增带型多数未表现出与菌株来源的联系,但少数菌株依来源不同表现出了一定区别。引物4和引物7可将来源于不同临床分型的97株菌及2株标准菌株分成19型和21型。结论 外阴阴道念珠菌病致病菌以白念珠菌为主,非白念珠菌中以光滑念珠菌为主。     

大剂量静脉注射免疫球蛋白治疗25例重症皮肤病的临床分析

目的 探讨大剂量静脉注射免疫球蛋白(大剂量IVIg)治疗中毒性表皮坏死松解症、药物超敏综合征、结缔组织病、自身免疫性疱病、急性移植物抗宿主病等重症皮肤病的临床疗效和不良反应.方法 应用免疫球蛋白0.4g·kg^-1·d^-1静脉滴注,每个疗程时间均为连续5d,治疗25例重症皮肤病.结果 大剂量IVIg对这25例重症皮肤病疗效各有差异,其中21例重症患者疗效较好,尤其是急性发病的中毒性表皮坏死松解症和药物超敏综合征效果最好;1例成人皮肌炎患者和2例老年大疱性类天疱疮患者未得到缓解,1例急性移植物抗宿主病患者死亡;仅3例患者出现轻微头痛、血压升高等.结论 大剂量IVIg是治疗某些重症免疫性皮肤病的有效手段,对于缩短病程、减少糖皮质激素和免疫抑制剂的用量、预防感染等方面疗效明显.     

HIV/AIDS患者口咽部念珠菌病与CD4+、CD8+T淋巴细胞分析

目的 研究HIV/AIDS患者的口咽部念珠菌病的发病特点,CD4⁺计数、CD8⁺计数、CD4⁺/CD8⁺比值的分布特点,以及抗真菌治疗的特点。方法 观察20例合并口咽部念珠菌病的HIV/AIDS患者和对照组口腔病损情况,病损部行真菌镜检和真菌培养,外周血流式细胞仪检测CD4⁺、CD8⁺计数。研究组和对照组伊曲康唑治疗第1周、第2周、疗程结束时、停药后两周真菌学疗效比较。结果 19例为白念珠菌感染,1例为近平滑念珠菌感染。20例艾滋病患者可见舌部感染6例,口腔侧壁感染14例。CD4⁺、CD8⁺计数和CD4⁺/CD8⁺比值分别在119.40±127.43、652.50±338.57和0.163±0.130范围。伊曲康唑治疗HIV/AIDS组第1周、第2周、疗程结束时、停药后两周真菌清除率分别为16.67%、50.00%、61.11%、66.67%。结论 HIV/AIDS患者口咽部念珠菌感染的最常见致病菌是白念珠菌,最常见靶部位是舌和口腔侧壁。HIV/AIDS患者的口咽部念珠菌病抗真菌疗效与免疫状态有关。     

白念珠菌分泌型天冬氨酸蛋白酶基因在急性念珠菌性外阴阴道炎中的表达

目的 了解白念珠菌分泌型天冬氨酸蛋白酶(Sap)基因在人类阴道白念珠菌感染时的表达情况。方法 收集9例阴道念珠菌检测阴性及20例阴道念珠菌感染者的阴道分泌物,通过用特异引物系列进行RT-PCR反应来评价Sap1~Sap6在人体阴道环境中的表达情况。结果 Sap2和Sap5在阴道白念珠菌感染者中是最主要的表达基因;Sap3和Sap4在所有检查者中均被检测到;所有6种Sap基因在某些阴道念珠菌病患者中同时被检出。结论 Sap基因可能与阴道念珠菌病的发病机制有关。     

阴道分离的念珠菌体外抗真菌药物敏感性分析

目的 探讨念珠菌在女性阴道黏膜所致的不同表现与其对抗真菌药物敏感性之间的关系。方法 应用NCCLSM27-A方案推荐的微量液体稀释法,测定对来自外阴阴道念珠菌健康携带者、外阴阴道念珠菌病和复发性外阴阴道念珠菌病的念珠菌对抗真菌药物的敏感性。结果 8种抗真菌药对光滑念珠菌和克柔念珠菌的MIC值几乎均比白念珠菌高。来自复发性外阴阴道念珠菌病患者的菌株MIC值较高,而健康带菌者菌株的MIC值较低。耐药菌株主要来源于复发组,健康带菌者来源的白念珠菌菌株对伊曲康唑、氟康唑、酮康唑和制霉菌素未见有耐药菌株出现。结论 外阴阴道念珠菌病治疗中应重视非白念珠菌的耐药性,长期或间断应用抗真菌药物治疗,可能诱导耐药株的产生。     

婴儿慢性皮肤黏膜念珠菌病一例及实验研究

目的 报道1例营养不良和免疫低下所引起的婴儿慢性皮肤黏膜念珠菌病.方法 取患儿不同部位皮损标本直接镜检、真菌培养、相关菌学鉴定试验及分子生物学实验,确定致病菌种及药物敏感范围.结果 患儿为5月女婴,大头貌,3个月前,无明显诱因在头、双耳廓、鼻孔、口腔、颈部、双腋下、臀部出现红斑、糜烂,表面结痂,伴瘙痒,头发、指趾甲生长不良.皮损刮取物进行真菌镜检和培养,发现臀部有白念珠菌生长,头屑有光滑念珠菌生长.淋巴细胞免疫表型分析CD16+566.5%,血清IgG6.74g/L,IgA321mg/L,血清白蛋白18g/L,均降低.提示患儿为低蛋白营养不良并存在免疫低下.结论 结合喂养史、临床和实验室检查诊断为继发性营养不良所致婴儿慢性皮肤黏膜念珠菌病.     

聚合酶链反应检测深部致病真菌的实验研究

目的 建立能用于临床实践的检测常见致病真菌的聚合酶链反应(PCR)方法.方法 设计了以热启动PCR为基础的实验方法,首先用真菌通用引物对标本进行单重PCR,若阳性,再用白念珠菌、烟曲霉和新生隐球菌的种特异性引物进行三重PCR来检测这3种常见致病真菌.结果 对9属55种78株常见深部真菌均扩增出260bp的DNA片段,而对细菌和人DNA均未扩增出目的 片段,具有高度特异性和敏感性,该方法操作简便且成本低.结论 以热启动PCR为基础的单重PCR和三重PCR方法可能成为临床上深部真菌感染理想的快速诊断工具.     

重症顽固性银屑病疗效不佳的相关因素分析

目的：探讨导致重症顽固性银屑病疗效不佳的相关因素。方法：采用回顾性前瞻研究方法．对40例重症顽固性银屑病患者初诊时填调查表，然后治疗并追踪随访1年，先将研究重点运用单因素非条件logitstic回归分析方法进行研究，冉将有意义的变量进行多因素非条件logistic回归分析。结果：40例患者有13例疗效不佳，单因素非条件logistic回归分析显示：心理因素中的焦虑、恐惧、负性生活事件刺激；生物物理因素中的感染、劳累、外伤；治疗因素中的系统用过糖皮质激素与重症顽固性银屑病患者疗效不佳有关，晰性别、年龄、病程、家族史与疗效无关。进一步将有意义的变量进行多因素非条件logistic回归分析发现：焦虑、劳累、患感染性疾病、系统用过糖皮质激素是导致重症顽固性银屑病患者疗效小佳的重要因素。结论：焦虑、劳累、负性生活事件刺激、患感染性疾病、系统用过糖皮质激素是导致顽固性银屑病患者疗效不佳的重要因素。     

结缔组织病患者咽部定植的白念珠菌毒力测定

目的了解结缔组织病患者咽部定植的白念珠菌芽管生成长度和分泌型天冬氨酸蛋白酶活性。方法采用病例对照方法对病例组30株和健康组4株白念珠菌芽管生成长度和分泌型天冬氨酸蛋白酶活性进行测定。结果病例组菌株芽管长度为(8.425±1.513)μm,显著高于健康组的(6.495±0.375)μm(P<0.05);病例组分泌型酸性蛋白酶活性Pa值为0.490±0.053,低于健康组的0.610±0.056(P<0.01)。白念珠菌生成的芽管长度与其分泌的酸性蛋白酶活性Pa值呈负性相关(r=-0.874,P<0.01)。结论与健康人相比,结缔组织病患者咽部定植的白念珠菌毒力较强,有更强的潜在致病力。     

Invasive fungal dermatitis in extremely premature newborns: a specific clinical form of systemic candidiasis

BACKGROUND: Fungal agents, chiefly Candida albicans, are the cause of rising morbidity and mortality in newborn infants weighing less than 1500 g. We studied the particular cutaneous effects during the course of these infections. PATIENTS AND METHODS: This was a retrospective 3-year study in premature infants weighing less than 1500 g and hospitalized in the neonatal department of the Lille University Teaching Hospital. The patients included in the study presented sepsis with isolation of Candida in blood and/or urine culture. RESULTS: Twelve infants were included (1.8%). The risk factors seen are those described in literature (broad-spectrum antibiotics, prolonged mechanical ventilation and parenteral nutrition, corticosteroids and central venous catheters). Infection occurred early (mean: D12) and affected extremely premature infants (mean: 25 weeks' amenorrhea) of low birth weight (mean: 758 g) generally born by vaginal delivery (9 of 12 infants). The sole fungal agent isolated was Candida albicans. In 10 of the 12 patients, a characteristic skin disorder was observed (erythema with erosion and desquamation). In 10 of the 12 patients, too, Candida was isolated from skin and/or mucosal samples. DISCUSSION: Although it is now universally accepted that antifungal treatment should be initiated without delay for candidemia in septic newborn infants at risk, diagnosis of systemic candidiasis remains delicate. However, a specific pattern of skin involvement is very commonly seen that is atypical for candidiasis, but which in addition to its diagnostic value indicates early colonization with Candida (first 2 weeks of life). In this setting of immaturity of the skin and immune system, colonization and proliferation in skin and/or mucosa appear to constitute the first stage of systemic infection and we may speak of invasive cutaneous-mucosal candidiasis in extremely premature infants and initiate treatment designed to prevent the disease becoming systemic..     

Disorders of steroid metabolism in inflammatory skin diseases

The corticosteroid and androgen metabolites in the urine of 37 test subjects (11 healthy volunteers, 16 patients with eczema, and 10 patients with psoriasis) were investigated by means of gas chromatography and mass spectrometry. In addition, we studied the cortisol and testosterone levels in the plasma by radioimmunoassay. Those patients who had been treated with corticosteroids during the last two weeks were excluded. Our findings revealed that the excretion rate of steroid metabolites was significantly reduced in dermatological patients. The excretion rate of corticosteroids in urine was decreased an average of 25% (eczema) and 29% (psoriasis). The reduction of the androgen metabolites amounted to 26% and 31%. Cortisol and testosterone levels in the plasma were normal in all the cases.     

Incidence of Ureaplasma urealyticum in endourethral swabs compared with first voided urine from men.

The incidence of Ureaplasma urealyticum in endourethral swabs was compared with that in first voided urine specimens from 171 male patients. The organism was isolated from the urethras of 72 (42%) and from the urine of 66 (39%). The interval since last voiding urine did not significantly influence the incidence of infection or ureaplasma counts in either type of specimen. Urethritis was strongly associated with ureaplasma counts of greater than or equal to 5 x 10(5) colour changing units (ccu)/ml in the urethra and greater than or equal to 5 x 10(3) ccu/ml in urine.     

Herpes zoster in the elderly.

Herpes zoster is a self-limited disorder which in most cases resolves without complications. The specific defect in host immunity that permits activation of latent V-Z virus and the occurrence of herpes zoster in both healthy and debilitated individuals has not yet been identified. In some patients, particularly the aged, complications occur during the acute phase of the disease or there are sequelae that may incapacitate the patient later. The most important of these is postherpetic neuralgia. In the elderly the chance of developing neuralgia following herpes zoster is about 50%. Involvement of the eye may produce minimal scarring or permanent blindness. There is an increasing incidence and severity of herpes zoster in association with malignant disease and in particular with Hodgkin's disease. Treatment of herpes zoster in the elderly should be determined by presenting symptoms. Topical medication such as the basic shake lotion is helpful. Personal experience and published reports suggest that early systemic administration of corticosteroids to healthy patients with severe herpes zoster pain with lessen the occurrence of postherpetic neuralgia. Administration of herpes zoster immune globulin is only effective in reducing the morbidity or preventing varicella in high risk individuals. ZIG does not affect the clinical course of herpes zoster.     

住院患者真菌感染的现况调查及病原学分析

目的　了解住院患者真菌感染的临床特点、发病率和疾病谱，为减少真菌感染提供依据。方法2006年1 - 12月间住院患者真菌培养阳性的病例，从患者年龄、疾病种类、标本、菌种分布、科室等方面进行分析。结果　住院患者真菌感染的发病率为5.07%，年龄分布在7 ～ 96岁之间，多为60岁以上患有基础疾病的老年人；感染部位以下呼吸道为最多；感染真菌主要为念珠菌属（93.68%），且以白念珠菌居多；所有患者均使用过2种或2种以上抗细菌药物。住院患者真菌感染的发生与多种广谱抗生素的使用、糖皮质激素或免疫抑制剂治疗、气管切开或插管、年龄≥60岁、留置导尿、恶性肿瘤性疾病等有关。结论　白念珠菌仍是住院患者真菌感染的主要病原菌。合理使用药物、减少侵入性治疗、提高机体免疫力是预防侵袭性真菌感染及改善预后的重要手段。     

The spectrum of skin disorders in abdominal stoma patients

BACKGROUND: Skin integrity is essential for the normal usage of a stoma appliance. However, there is little published on the prevalence, nature or management of stoma-related skin disorders. Objectives To document stoma-related skin disorders in a large cohort of patients. METHODS: We sent a postal questionnaire to all surviving patients who had had abdominal stoma surgery at Hope Hospital, Salford, U.K. in the 10 years from 1 January 1989. Those reporting skin disease were invited to attend a clinic run by a dermatologist and a stoma-care specialist nurse. All lesions were categorized and swabs taken for microbiological examination. RESULTS: Of 525 surviving patients, 325 (62%) replied to the questionnaire. Of these, 73% reported a skin problem that had affected normal stoma bag use. Dermatoses included irritant reactions, particularly from leakage of urine or faeces (42%); pre-existing skin diseases, principally psoriasis, seborrhoeic dermatitis and eczema (20%); infections (6%); allergic contact dermatitis (0.7%) and pyoderma gangrenosum (0.6% annual incidence). A further 15% of patients with skin problems had persistent or recurrent dermatitis not explained by allergy, frank infection or faecal irritation. This responded to short-term treatment with topical corticosteroids. Further investigation is under way into its pathogenesis. CONCLUSIONS: Skin disorders are common in stoma patients, and various patterns can be recognized and effectively treated.     

妊娠合并梅毒感染者发生不良妊娠结局的临床调查研究

目的:分析妊娠合并梅毒感染孕妇发生不良妊娠结局的影响因素,为妊娠合并梅毒感染孕妇临床治疗方案选择提供参考。方法:回顾性分析我院2010年12月至2015年10月期间收治的324例妊娠合并梅毒感染患者,统计孕妇出现不良妊娠结局的情况,比较不良妊娠结局和正常妊娠结局两组患者临床资料的差异,采用logistic多因素回归分析妊娠合并梅毒患者发生妊娠不良结局的影响因素。结果:324例妊娠合并梅毒感染患者中有24例(7.41%)出现不良妊娠结局,对正常组300例患者和不良结局组24例患者的临床资料分析,结果显示,产次、年龄、就诊时梅毒分期、其它传染病、驱梅疗程、随访执行情况是影响妊娠合并梅毒感染患者妊娠结局的相关因素;经logistic多因素回归分析,就诊时梅毒为中晚期期、有其它传染病、完成驱梅疗程≤1、未严格执行随访计划是妊娠合并梅毒感染患者妊娠结局不良的危险因素。结论:妊娠合并梅毒感染患者的不良妊娠结局发病率较高,影响妊娠合并梅毒感染不良妊娠结局的因素较多,在加强对孕妇进行梅毒筛查的同时,应加强梅毒感染孕妇的后续治疗和管理,确保梅毒感染得到有效控制,降低梅毒感染对妊娠结局的不良影响,提高孕妇的妊娠预后。     

Urine and the laboratory diagnosis of Chlamydia trachomatis in males.

OBJECTIVE--To determine whether the use of urine samples from male patients can replace urethral swabs for the rapid detection of Chlamydia trachomatis by the Pharmacia EIA. SETTING--The STD clinic, Adelaide, South Australia. PATIENTS--There were two separate groups of male patients. Group A (398) patients provided urethral specimens for the EIA and culture tests. The patients in Group B (356) provided an urethral swab and a urine sample for the EIA test. METHODS--The urine samples and urethral swabs were tested for the presence of C trachomatis by the Pharmacia Chlamydia EIA. In addition, the urethral swabs from Group A patients were cultured for the organism by standard cell cultures. The infected cell cultures were identified by an immunofluorescence test using a FITC-monoclonal antibody to C trachomatis (Kallestad). RESULTS--When the EIA was validated against culture, it showed a sensitivity of 100% and a specificity of 95% with the urethral swabs from Group A patients. The urine specimens were positive in 24% of those patients who yielded a positive EIA result in the urethral swabs. CONCLUSIONS--Although the EIA test on urethral swabs showed high sensitivity and specificity when validated against culture, our results showed that the use of urine samples cannot replace urethral swabs for the laboratory diagnosis of this sexually transmitted disease.