中药单体成分抗白念珠菌实验的研究进展

 近年来随着激素、生物制剂的广泛使用以及HIV、癌症发病率的升高,免疫低下人群逐渐增多,条件致病菌白念珠菌的感染逐年增多,其对抗真菌药物的耐药作用也日渐突出。中药单体成分具有良好的抗真菌作用,毒副作用小,可与抗真菌药物协同作用,降低真菌耐药性,越来越引起重视。本文就中药单体成分小檗碱、黄芩苷、苦参碱等抗白念珠菌的相关实验研究进展作一综述。      

中药干预白念珠菌的实验研究进展

中药抗真菌作用研究历史悠久,从天然中药中寻找筛选抗真菌新药或研发针对耐药白念珠菌的药物,是近年研究的热点.本文对中药活性成分、中药单体和中药复方对白念珠菌的干预作用实验研究进展方面进行了综述.     

中药抗真菌作用的研究进展

中药作为抗真菌药物,具有价格低廉、资源丰富、不良反应小、不易耐药等优点。该文通过对单味中药、复方中药、中西药协同抗真菌作用及中药抗真菌作用的机制及近年来中药抗真菌的研究现状进行综述,为临床抗真菌治疗提供理论依据。     

用流式细胞术研究中药对白念珠菌的抗菌作用

目的 应用流式细胞仪测定中药有效成分小檗碱、黄芩甙、丁香酚和姜黄素对白念珠菌细胞周期的影响。方法 将白念珠菌培养在含不同药物浓度的YEPD培养基中，培养48h，流式细胞仪检测细胞生长周期、DNA荧光强度和细胞体积大小。结果 4种抗真菌中药有效成分对白念珠菌细胞生长周期有不同程度的影响，随着药物浓度的增高，其处于S-G2-M期的细胞比率越低，亦即细胞分裂受抑制越明显。在含药物培养基中生长的真菌细胞的荧光强度减弱，反映了细胞DNA片段的丢失，并随着药物浓度的升高，荧光强度减弱越明显，反映细胞体积大小、折光度和颗粒度的散点图向下和向左移动，随着药物浓度的升高，这种图形变化越明显。结论 中药单体通过抑制细胞分裂发挥抗真菌作用，流式细胞仪可用于抗真菌药物敏感性测定。     

格尔德霉素和环孢素联合常用抗真菌药对阿萨希毛孢子菌临床株体外药敏研究

目的研究格尔德霉素和环孢素(热休克蛋白90与钙调磷酸酯酶抑制剂)抗阿萨希毛孢子菌活性,及联合常用抗真菌药物后的体外药物敏感性。方法通过美国临床实验室标准化协会(CLSI)推荐的M27-A3肉汤稀释法检测格尔德霉素和环孢素对21株阿萨希毛孢子菌临床株的体外抗真菌活性,棋盘微量液基稀释法检测上述2种抑制剂与5种常用抗真菌药(氟康唑、伊曲康唑、伏立康唑、两性霉素B和卡泊芬净)的相互作用。结果格尔德霉素对阿萨希毛孢子菌临床株有较好的体外抗真菌活性,而环孢素作用较弱。此外,格尔德霉素和环孢素与5种常用抗真菌药联合使用,均显示具有良好的体外抗阿萨希毛孢子菌协同作用。结论格尔德霉素和环孢素可以提高常用抗真菌药对阿萨希毛孢子菌的敏感性,提示一种针对侵袭性毛孢子菌病的潜在治疗策略。     

中药成分抗白念珠菌的实验研究进展

近年来随着抗生素、激素、免疫抑制剂等药物的广泛应用,临床上以白念珠菌为代表的真菌感染的比例也相对提高,真菌对药物的耐药问题也越来越突出。因此,开发研究既可有效对抗真菌感染,毒副作用又较小,适合免疫力低下人群使用的抗真菌药物显得越来越重要。我国有着丰富的中药资源,医药工作者近几年对此作了大量的研究,希望找出有效的抗真菌药物,笔者通过搜索大量的文献资料总结了近几年的研究成果。     

抗真菌药物的协同作用

目前真菌感染,尤其是酵母菌感染的发病率和严重度在不断增加,并且随着耐药菌株的出现可选择的药物又很有限, 这些都增加对新药和新治疗途径的需求。近年来人们尝试通过联合抗真菌药物,产生协同作用从而拓宽抗菌谱,获得杀菌活性并且降低耐药风险。本文综述了这类研究的常用方法和针对各种不同的真菌所能联合应用的药物。     

抗真菌药物的协同作用

目前真菌感染 ,尤其是酵母菌感染的发病率和严重度在不断增加 ,并且随着耐药菌株的出现可选择的药物又很有限 ,这些都增加对新药和新治疗途径的需求。近年来人们尝试通过联合应用抗真菌药物 ,产生协同作用从而拓宽抗菌谱 ,获得杀菌活性并且降低耐药风险。本文综述了这类研究的常用方法和针对各种不同的真菌所能联合应用的药物。     

伏立康唑抗致病真菌的研究进展

伏立康唑是第二代合成的氟康唑衍生物 ,该文对其抗真菌机理进行了介绍 ,并就其与其他抗真菌剂对念珠菌属及念珠菌属以外的其他真菌的体外活性试验的比较结果 ,以及临床应用和与其他抗真菌剂的协同作用作一综述 ,为临床治疗真菌病推荐了一种新的有效药物。     

抗真菌药物作用机理的研究进展

抗真菌药物作用机理的研究发展是新抗真菌药物的必要手段。近来问世的氟康唑和睫状真菌素都因具有独特的抗真菌机制才受到广泛的重视.本文从药物作用机制入手,介绍目前抗真菌药物的研制状况,概述各类药物的作用特点和发展方向,以供临床参考。     

9种中药单体的体外抗单梗着色霉活性评价

 目的： 体外检测中药单体对单梗着色霉的抑菌活性,为临床采用中药治疗着色芽生菌病提供实验依据。方法：11株单梗着色霉菌株为实验菌株,包括1株标准株、10株临床分离株。参照CLSI制定的M38-A2,采用微量稀释法检测蛇床子素、姜黄素、白鲜碱、知母皂苷、黄芩苷、苦参碱、丹皮酚、斑蝥素和大黄酚 9种中药单体对单梗着色霉的抑制作用。结果：9种中药单体最小抑菌浓度（MIC）的几何均数为14.11～272.65 μg/mL,蛇床子素、姜黄素和白鲜碱的抑菌活性最佳,几何均数分别为14.11、28.21、52.98 μg/mL;蛇床子素的抗菌作用最强,MIC范围为8～32 μg/mL。 9种中药单体 最小杀菌浓度(MFC)为128~>1 024 μg/mL;蛇床子素的 MFC值最低,几何均数为272.65 μg/mL。结论：蛇床子素、姜黄素、白鲜碱、知母皂苷、黄芩苷、苦参碱、丹皮酚、斑蝥素和大黄酚对单梗着色霉具有一定的抑菌活性,不同中药单体抑菌活性存在差异。     

Advances in topical and systemic antifungals

Topical antifungal agents are generally used for the treatment of superficial fungal infections unless the infection is widespread, involves an extensive area, or is resistant to initial therapy. Systemic antifungals are often reserved for the treatment of onychomycosis, tinea capitis, superficial and systemic candidiasis, and prophylaxis and treatment of invasive fungal infections. With the development of resistant fungi strains and the increased incidence of life-threatening invasive fungal infections in immunocompromised patients, some previously effective traditional antifungal agents are subject to limitations including multidrug interactions, severe adverse effects, and their fungistatic mechanism of actions. Several new antifungal agents have demonstrated significant therapeutic benefits and have broadened clinicians' choices in the treatment of superficial and systemic invasive fungal infections.     

Fungal melanonychia

Fungal melanonychia is a relatively rare nail disorder caused by nail infection that produces brown-to-black pigmentation of the nail unit. The number of organisms implicated as etiologic agents of fungal melanonychia is increasing, and the list currently tops 21 species of dematiaceous fungi and at least 8 species of nondematiaceous fungi. These superficial infections may clinically mimic subungual melanoma and are often not responsive to traditional antifungal therapy. This article reviews the literature on fungal melanonychia and the role of fungal melanin in infection.     

Successful Treatment of Candida albicans Septicemia in a Preterm Infant with Severe Congenital Ichthyosis (Harlequin baby)

Abstract:  Candida infections are a major cause of fungal septicemia in neonates and are associated with marked morbidity and mortality. Despite the spectrum of antifungal drugs being dramatically extended during the last decade, invasive fungal infections remain a serious challenge for neonatologists. Amphotericin B and its lipid formulations are the drugs of choice for the treatment of systemic candidiasis in neonates. The combination of antifungal drugs with different sites of action, like caspofungin and amphotericin B, may improve antifungal efficacy. Severe congenital ichthyosis often leads to death within the neonatal period. Main causes of death are dehydration, electrolyte disturbances, and respiratory or systemic infections. We report the case of a preterm infant with severe congenital ichthyosis and sepsis caused by Candida albicans . The infection did not improve despite proper liposomal amphotericin B treatment. After addition of caspofungin, the baby recovered. To our best knowledge, a case of a preterm infant suffering from severe congenital ichthyosis and Candida albicans sepsis, who survived, has not been previously described.     

中西医结合在防治宫颈HPV感染癌前病变及术后复发中的探讨

目的：探讨清除HPV的有效治疗方案,阻断宫颈癌演进,预防术后复发。方法：用西医、中医、中西医结合的方法。结果：西医从物理疗法发展到HPV疫苗的研究,但仍无彻底清除HPV的有效方法,复发率高;中医认为正虚邪侵,治拟内外合治,扶正补虚,清热利湿,解毒消瘕。相对价廉、副作用小、能清除HPV,预防C IN及防止复发,但疗效较慢;中西医结合则扬长避短,对有物理、手术治疗指征的宫颈癌前病变者,先予局部物理或手术治疗,再辨证施治：全身治疗以内服中药为主,改善机体的失衡状态,提高免疫功能,扶正祛邪,排毒消瘕;局部治疗以宫颈敷药,祛腐生新,促进术后创面愈合,抗癌排毒,清除残存的HPV。结论：物理或手术清除宫颈局部病灶与中药清除HPV相结合,有望彻底清除HPV,达到预防、治疗HR HPV感染,逆转C IN及防止术后复发,阻断宫颈癌演进的目的。     

Systemic candidiasis

Systemic candidiasis is a disease of increasing incidence and proportions, which appears to be associated with the advances in modern medicine. It involves primarily patients with severe debilitating and malignant disease who are receiving immunosuppressive, cytotoxic, antimetabolite, and antibiotic therapy. Side effects of these otherwise major therapeutic agents predispose patients to opportunistic fungal infections, of which candidiasis is the most common. The high morbidity and mortality of disseminated candidiasis in neutropenic patients are difficult obstacles to obtaining the optimal, if not full, potential of modern chemotherapy for cancer. The inability to diagnose early invasive and systemic candidiasis is a major handicap that delays timely initiation of antifungal therapy. The paucity of highly efficacious antifungal agents with low toxicity severely limits the ability to successfully cure systemic fungal infections in cancer patients. Aggressive research into the basic biology of Candida spp. is necessary for directing the development of better diagnostic methods and improved antifungal drugs.     

粉防己碱对酮康唑抗近平滑念珠菌复合体的体外增效活性研究

目的 探讨粉防己碱在体外对酮康唑抗近平滑念珠菌复合体有无增效作用.方法 参照美国临床和实验室标准协会(CLSI)推荐的M27-A3方案,采用棋盘式微量稀释法测定酮康唑单独及联合粉防己碱抗21株近平滑念珠菌复合体临床株抗真菌活性,结合部分抑制浓度指数(FICI)对结果进行评价;以甲基四氮盐(XTT)法分别测定不同时间点药物作用的效果,绘制时间杀菌曲线,动态观察药物体外抗近平滑念珠菌复合体活性.结果 粉防己碱与酮康唑单独作用于21株近平滑念珠菌复合体菌株的最低抑菌浓度分别是32～64 mg/L和0.031 25～2 mg/L,两药联合时最低抑菌浓度分别降至2 ～8 mg/L和0.008～0.25 mg/L,FICI值为0.09 ～ 0.5;时间杀菌曲线表明,与酮康唑单用组和粉防己碱单用组相比,酮康唑联合粉防己碱组真菌生长延迟明显.结论 粉防己碱在体外对酮康唑抗近平滑念珠菌复合体有明显的增效作用.     

Amphotericin B-resistant Aspergillus flavus infection successfully treated with caspofungin,a novel antifungal agent

Invasive aspergillosis is uncommon in immunocompetent hosts but is the second most common opportunistic fungal infection in immunocompromised patients. There has been a dramatic increase in the incidence of life-threatening aspergillosis during the past 2 decades, and the morbidity and mortality of these infections despite antifungal therapy remain unacceptably high. We describe a patient with amphotericin B-resistant Aspergillus flavus successfully treated with caspofungin, an agent belonging to a new class of antifungal drugs. Caspofungin shows great promise in the treatment of invasive aspergillosis.     

重症监护病房患者深部真菌感染分析

目的探讨笔者所在医院重症监护病房（ICU）患者深部真菌感染的发病特点,并了解院内深部真菌感染常见致病菌的耐药情况。初步探讨院内深部真菌感染高危因素,对相关因素进行分析,为有效控制真菌感染及合理用药提供参考依据。方法采用前瞻性对照研究,对2011年1月～2012年6月入住ICU经筛选符合条件的231例患者作为研究对象,随访和调查患者的性别、年龄、住院时间、基础疾病,是否有侵入性操作、使用抗真菌药物情况,以及部分血生化检查指标,同时记录真菌感染者致病菌种及药敏试验结果。结果231例患者中真菌感染者37例,深部真菌的发病率为16．02％。真菌感染部位以下呼吸道感染最为常见。从血液、尿液、痰液、胸腔积液、腹水、脑脊液等标本中共分离出菌株45株,其中酵母菌42株,霉菌3株,酵母菌中以白念珠菌（18株）最为多见。真菌培养药敏试验结果显示抗真菌药物对深部真菌的敏感性分布有明显的种问差异。结论①深部真菌感染以白念珠菌最为常见,其次是热带念珠菌、光滑念珠菌、曲霉。真菌感染部位以下呼吸道感染最为常见。药敏试验结果显示,抗真菌药物对深部真菌的敏感性分布有明显的种间差异。②高龄、住院时间长、抗菌药物的广泛应用、各种侵入性操作的使用、高血糖、低蛋白血症、贫血是ICU患者深部真菌感染的高危因素。