伊曲康唑间歇冲击疗法治疗甲真菌病临床追踪观察

目的 评价伊曲康唑间歇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、安全性及停药2年内的复发率.方法 采用间歇冲击疗法,连续服用伊曲康唑(2次/d,200mg/次,国药准字H20020367)7d,停药21d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、6个月指(趾)甲真菌病的临床治愈率及2年内甲真菌病的复发率.结果 疗程结束时,停药后3个月、6个月时指甲真菌病的临床治愈率分别为23.17%、80.49%和91.46%;指(趾)甲同患真菌病的临床治愈率分别为13.56%、62.71%和81.36%.疗程结束后,经追踪观察,随时间延长治愈率不断提高,停药后6个月达到最高.指甲真菌病治愈率高于趾甲真菌病.停药2年内复发率为14%.结论 伊曲康唑间歇冲击疗法治疗甲真菌病具有疗效高、副作用小、安全性好、耐受性高、复发率低的特点.     

伊曲康唑间歇冲击疗法治疗甲真菌病80例分析

目的 观察伊曲康唑间歇冲击疗法治疗甲真菌临床疗效.方法 8o例甲真菌痛患者每天口服伊曲康唑胶囊2次,每次200mg,共7d,停药21d为1个疗程.指甲真菌病用药2个疗程,趾甲真菌病及指(趾)甲同患真菌病用药3个疗程.结果 35例指甲真菌病临床痊愈率为91.4%,45例趾甲真菌病及指(趾)甲同患真菌病临床痊愈率为84.4%,二者伴发皮肤真菌感染者真菌清除率分别为97%、96%.结论 伊曲康唑短期冲击疗法治疗甲真菌病疗程短,疗效高,不良反应小,安全性高,复发率底.     

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。     

甲真菌病治疗中值得注意的几个问题

甲真菌病的治疗是近年来皮肤科研究的热点之一 ,新近发表的“特比奈芬连续疗法与伊曲康唑冲击疗法治疗趾甲真菌病疗效和耐受性的比较 (Ｌ .Ｉ .ＯＮ)”一文结论认为 :“治疗趾甲真菌病 ,兰美舒比斯皮仁诺更为有效”。此后 ,一些作者如Ｅｌｅｗｓｋｉ等提出了不同的看法 ,笔者在此亦提出有关的几个问题 ,供研究探讨。一、甲真菌病与甲癣这是两个不同的概念 ,甲真菌病是指真菌侵犯到甲板而引起感染。引起甲真菌病的病原菌有三大类 :皮肤癣菌、酵母菌和霉菌。甲癣是指皮肤癣菌侵犯甲板而引起的甲损害。大多学者包括Ｌ .Ｉ .ＯＮ的作者也认为甲…     

伊曲康唑治疗甲真菌病52例疗效及后效应观察

目的 详细观察伊曲康唑对甲真菌病的效果及后效应，方法 用伊曲康唑间歇冲击疗效法治疗甲真菌病５２例，结果 治疗结束时指甲真菌病临床有效率为４５．５％，趾甲真菌临床有效率为４１．５％，用药第４０周指甲真菌病有效率为９０．９％，趾甲真菌病有效率为９０．２５％，治疗结束时疗效与用药第４０周疗效相比，其临床有效率在统计学上有非常显著差异，结论 伊曲康唑治疗甲真菌病有良好的“药物后效应”。     

伊曲康唑治疗甲真菌病

甲真菌病是最常见的甲病,其致病真菌可以分为三类:皮肤癣菌,酵母菌和非皮肤癣菌的霉菌感染.通常认为在这三类致病真菌中,皮肤癣菌最为常见.以往口服药物治疗以灰黄霉素,酮康唑为主,这些药物需要长期服用,给患者带来严重的毒副作用,目前已经很少采用.伊曲康唑有较强的亲脂性,经口服后能较快进入甲根、甲板、甲床及甲板之间的组织,而且抗菌谱广,对皮肤癣菌、酵母菌、霉菌都有较好的疗效,因此选用伊曲康唑通常能有很满意的疗效.     

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     

172例真菌病真菌培养结果分析

目的 探讨真菌病真菌培养结果并进行分析.方法 回顾性分析2010年6月至2012年2月入我院临床科室进行治疗的172例真菌病镜检阳性患者的临床资料,对其行真菌培养后,后进行统计和分析真菌病的菌种组成、临床分类及病原体分布情况.结果 172例真菌病标本真菌培养检出阳性133例,检出率为77.3%.一共分离出致病菌株134个:本研究中致病菌菌株主要包括皮肤癣菌、酵母菌和霉菌三种.三者中以皮肤癣菌为主.在皮肤癣菌中红色毛癣菌占绝大多数,在酵母菌中主要致病菌为念珠菌属类,在霉菌中曲霉和青霉为常见.皮肤癣菌为趾甲主要致病菌,皮肤癣菌和酵母菌为指甲主要致病菌,霉菌感染趾甲高于指甲,混合感染很少发生.不同性别之间比较不同致病菌发病率,P>0.05,差别无统计学意义.结论 皮肤癣菌在甲真菌病病原体中分布最为广泛,其次为酵母菌,分布较少的为霉菌.其中皮肤癣菌中最常见的是红色毛癣菌,酵母菌感染中最常见的是白念珠菌和近平念珠菌,霉菌和混合感染在临床中发病率较低.     

特比奈芬治疗88例儿童甲真菌病临床观察

目的 观察特比奈芬治疗儿童甲真菌病的疗效及安全性.方法 应用特比奈芬治疗儿童指甲真菌病50例及趾甲真菌病38例,并作疗效、真菌清除率及安全性观察.结果 特比奈芬治疗儿童指甲真菌病的痊愈率及总有效率分别为9.1%和97.37%;趾甲真菌病则分别为86.36%和93.94%.真菌清除率均达到96.59%.在本临床研究中未发现特比奈芬有严重的毒副反应.结论 特比奈芬治疗儿童甲真菌病疗效显著、安全性高,是有效根治儿童甲真菌病的方法之一.     

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％，酵母菌３２．１％，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。酵母菌感染指甲的百分率明显高于趾甲。     

Itraconazole and Nail Scraping in the Treatment of Onychomycosis (A open trial of 175 cases)

Onychomycosisisacommonskindiseaseaffecting2%-5%ofthegeneralpopulation[1].Theincidenceofonychomycosisinourclinicis0.8%,whichislowerthanthereportedincidence10%-15%intheliterature.Onychomycosisisoneofthemostdifficultdiseasestomanage.Thedifficultyliesinthepenetrationofatopicalantifungalagenttonailmatrixandnailbed.Recentlyoralitraconazole,terbinafineandfluroconazolehavebeenused,buttheantimycotictherapyrequireslong-termoraladministrationandhaspotentialhepatotoxicity.Nowitisavailablefortreatingtheon…     

伊曲康唑联合甲床修整术治疗重症甲真菌病的疗效观察

目的观察口服伊曲康唑联合甲床修整术治疗重症甲真菌病的临床疗效。方法将140例甲真菌病患者随机分为两组,治疗组68例采用甲床修整术联合口服伊曲康唑治疗;对照组72例单纯口服伊曲康唑治疗。结果治疗组痊愈率及总有效率分别为70.6%及88.2%,对照组分别为45.8%及65.2%,两组患者痊愈率及总有效率差异均有显著统计学意义（P〈0.01）。结论伊曲康唑口服联合甲床修整术治疗重症甲真菌病疗效高,能显著改善新甲的生长速度及外观。     

Analysis of the factors influencing the therapeutic effects of onychomycosis

From July 1 994to June 1 999,5 4 5 onychomyco-sis patients were treated with Itraconazole and com-pleted their treatment courses with complete follow-up in out- patientdepartment.The recovery rate was83.1 4% and 79.2 3% in fingernail and toenail dis-eases respectively.But following phenomena werefound:( 1 ) Some new nails stopped growing in cer-tain length,even if the treatment continued;( 2 )Some damaged nails reappeared soon after the treat-ment ceased;( 3) Some damaged nails with deep- co…     

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.

     

三种常见抗真菌药口服治疗甲真菌病疗效观察

目的了解伊曲康唑、特比萘芬和氟康唑口服治疗甲真菌病的疗效。方法63例患者根据治疗药物的不同分为三组,伊曲康唑组41例,特比萘芬组13例,氟康唑组9例。分别在疗程结束后3个月和6个月时,进行真菌学检查和临床症状观察。结果伊曲康唑、特比萘芬和氟康唑治疗结束3个月和6个月的临床有效率分别为87．80％和92．68％、84．62％和92．31％、88．89％和88．89％;治疗结束3个月和6个月真菌学治愈率一致,分别为100％、92．31％和100％％。结论伊曲康唑与特比萘芬和氟康唑治疗甲真菌病均能取得较好的疗效。美扶因价格相对便宜,抗菌谱更广,具有更高的效价比。     

Treatment of dermatophyte toenail onychomycosis in the United States. A pharmacoeconomic analysis

This study attempted to determine the cost-effectiveness of therapies for dermatophyte toenail onychomycosis in the United States in 2001. The antimycotic agents evaluated were ciclopirox 8% nail lacquer and the oral agents terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A treatment algorithm for the management of onychomycosis was developed, and a meta-analysis was carried out to determine the average mycologic and clinical response rates for the various agents. The cost of the regimen was figured as the sum of the costs of drug acquisition, medical management, and management of adverse effects. The expected cost of management and disease-free days were determined, and a sensitivity analysis was conducted. It was concluded that ciclopirox 8% nail lacquer, which has recently become available in the larger size of 6.6 mL, is a cost-effective agent for the management of toenail onychomycosis.     

A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong

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两种方案治疗甲真菌病的疗效观察

目的观察伊曲康唑间歇冲击疗法和序贯疗法治疗甲真菌病的临床疗效。方法 51例患者根据治疗药物的不同分为伊曲康唑组和序贯疗法组,分别在治疗疗程结束后3个月、6个月和24个月进行真菌学检查、临床疗效和再发率观察。结果伊曲康唑组远期临床有效率为84.62%、序贯疗法组为92.00%,两组差异无统计学意义（P〉0.05）;伊曲康唑组24个月再发率为35.29%、序贯疗法组为5.00%,两组差异有统计学意义（P〈0.05）。结论两组均取得较好疗效,但序贯疗法组相比伊曲康唑组具有再发率低的优势。     

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.