皮肤利什曼病1例

患者男,50岁。左小腿斑块、结节1年半。无发热等全身症状,临床表现为左小腿斑块、结节。皮损组织病理示:肉芽肿性炎症,见大量嗜碱性小体线状分布于空泡边缘。予伊曲康唑胶囊200mg,2次/d口服,连续3个月,静滴两性霉素B脂质体20d,后改为伊曲康唑口服液至总疗程6个月治愈停药,随访2年未见复发。临床诊断:皮肤利什曼病。     

国产伊曲康唑治疗念珠菌性阴道炎临床观察

目的　观察国产伊曲康唑治疗念珠菌性阴道炎的临床疗效。方法　口服国产伊曲康唑胶囊 2 0 0mg ,1次 /d ,共 3天 ,治疗 99例念珠菌性阴道炎患者 ,观察其治疗前后症状评分变化。结果　痊愈率 81.82 %例 ,有效率90 .91%。结论　国产伊曲康唑可有效治疗念珠菌性阴道炎 ,无明显不良反应。     

伊曲康唑和特比萘芬联合治疗趾甲真菌病

为研究伊曲康唑及特比萘芬平行冲击治疗甲真菌病的疗效及药物经济学评估。甲真菌病患者随机分为治疗组46例服用伊曲康唑200mg 特比萘芬250mg,每日1次,连用7d,停药21d为1个疗程,共3个疗程;对照组45例采用伊曲康唑冲击疗法,共3个疗程。结果:两组近远期治愈率、有效率、真菌学治愈率,均无显著差异;临床治愈者24个月内,复发或再感染率分别为治疗组10.81%、对照组30.30%,P<0.05,有显著性差异;治疗组费用-效果比低于对照组,每治愈1例分别需人民币1093.56元和1357.36元。伊曲康唑及特比萘芬平行冲击治疗甲真菌病疗效确切、安全性好和复发率低,且较单一口服药物治疗具有更好的效价比。     

特比萘芬与伊曲康唑治疗甲真菌病疗效的Meta分析

目的系统评价特比萘芬与伊曲康唑治疗甲真菌病的有效性。方法计算机检索Cochrane图书馆、MEDLINE,Springer Datebase,CNKI,纳入所有比较特比萘芬与伊曲康唑治疗甲真菌病的随机对照试验(RCT)。由2名研究者共同独立提取资料并评估纳入研究质量。采用Cochrane协作网提供的RevMan4.2软件对试验数据进行统计分析。结果最终纳入6个RCT,其中4个特比萘芬250mg/d连续疗法与伊曲康唑200mg/d连续疗法、2个特比萘芬250mg/d连续疗法与伊曲康唑400mg/d冲击疗法治疗甲真菌病。Meta分析结果显示特比萘芬与伊曲康唑疗效的差异有统计学意义,合并后前者RR=1.25,95%CI(1.06～1.48),后者RR=2.02,95%CI(1.47～2.78)。均未报道特比萘芬和伊曲康唑引起的严重系统性不良反应。结论现有临床证据表明,特比萘芬治疗甲真菌病的疗效优于伊曲康唑。     

伊曲康唑加局部温热疗法治疗着色芽生菌病

目的　观察伊曲康唑加局部温热疗法治疗着色芽生菌病的疗效和安全性。方法　 12例给伊曲康唑 2 0 0mg 2次 /d ,连续 7天后改变为 10 0mg 2次 /d ;同时局部热疗 ,40℃～ 60℃。 结果　 11例培养阳性的患者的病原菌均为卡氏枝孢霉。 12例患者全部治愈。疗程 1.5～ 5 .5月 ,平均 (3 .1± 1.2 )月 ,伊曲康唑用量为 10 .5～ 3 5 .0 g ,平均 (19.8± 7.2 )g。病程小于 3年的患者疗程短于病程长于 3年者。结论　伊曲康唑加局部温热疗法治疗卡氏枝孢霉引起的着色芽生菌病疗效好、副作用小 ,病程长的患者所需疗程较长     

伊曲康唑治疗浅表念珠菌感染临床经验回顾

目的：评价适宜国人的伊曲康唑治疗浅表念珠菌感染的治疗方案。方法：复习10年来在我国皮肤科中文核心期刊上发表的有关伊曲康唑治疗浅表念珠菌感染的文献。结果：伊曲康唑治疗皮肤念珠菌感染的有效剂量为200mg／d，连续应用3d；治疗念珠菌性包皮龟头炎的有效剂量为200mg／d，连续应用5d；治疗初发性念珠菌性阴道炎的有效剂量为400mg／d，连续应用2d；治疗复发性念珠菌性阴道炎的有效剂量为400mg／d，以后在每月月经期加用伊曲康唑200mg／d，应用3～5d，连续3～6个月。结论：伊曲康唑治疗国人浅表念珠菌感染安全有效，不良反应发生率较低。     

伊曲康唑与氟康唑治疗66例复发性念珠菌阴道炎疗效比较

目的：了解应用伊曲康唑与氟康唑治疗复发性念珠菌阴道炎的临床疗效。方法：66例临床确诊为念珠菌阴道炎,随意分类两组：伊曲康唑组：200mg,每日一次,连续3天为一疗程,氟康唑组：100mg,每日一次,连续3天为一疗程,两组均连续治疗三个月共3个疗程。结果：伊曲康唑组,治疗后1、4、8、12周的总有效率分别为：85．3％、88．2％、91．2％、91．2％,氟康唑组治疗后1、4、8、12周的总有效率分别为81．3％、87．5％、78．1％、75．0％。治疗后1、4、8、12周两种药物治疗的总有效率相比差异无显性（P＞0．05）,但伊曲康唑治疗后第8、12周的复发率远低于氟康唑治疗组。结论：伊曲康唑与氟康唑治疗复发性念珠菌阴道炎均有较好的疗效,其远期疗效伊曲康唑优于氟康唑。     

伊曲康唑与灰黄霉素治疗儿童头癣的随机双盲对比研究

最近已有报道用伊曲康唑治疗由犬小孢子菌所致的头癣有效。为进一步观察伊曲康唑的安全性和副作用,对伊曲康唑与灰黄霉素治疗头癣进行了双盲对比观察。 材料和方法:按随机双盲法将患者分成两组,分别与食物同时口服伊曲康唑100mg/d或灰黄霉素500mg/d,共6周。在治疗开始及治疗第2、4、6周和治疗结束后第2、4、8周进行临床评分和真菌学检查。治疗结束后第4、8周进行总的疗效评估。伊曲康唑组18例,女6例,男12例,除1例为成人外其余年龄均小于12岁;     

婴儿及儿童多剂量服用伊曲康唑口服液的药代动力学

血液恶性疾病或肝移植患儿并发真菌感染(大多为念珠菌或曲霉感染 )已成为发病率及死亡率不断上升的原因。伊曲康唑为一广谱抗真菌药物 ,在体外有抗曲霉活性 ,可用于预防和治疗免疫功能低下儿童粘膜及侵入性真菌感染。由于婴儿和儿童服用胶囊有困难 ,为方便给药 ,作者开发了以羟丙 β-环糊精为助溶剂的伊曲康唑口服液 (标示量 1 0ｍｇ/ｍｌ,羟丙 β-环糊精40 0ｍｇ/ｍｌ)用于儿童。成年白血病患者以每日5ｍｇ/ｋｇ剂量给药 ,血清药峰浓度大于 2 5 0ｎｇ/ｍｌ,高于肺部抗曲霉感染的有效浓度。但儿童服用伊曲康唑后的药代动力学数据很有限 ,且…     

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：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胶囊冲击疗法,每日中晚餐各口服200mg,连用1周,停药3周为一个疗程。实验组在对照组的基础上接着应用盐酸特比萘芬冲击疗法,每日中晚餐各口服250mg,连用1周,停药3周为一个疗程。指甲真菌病治疗2个疗程,3、6个月时各复诊一次。趾甲真菌病治疗3个疗程,4、6、9个月时各复诊一次。治疗前后均进行血、尿常规、肝肾功能检查,并记录不良反应情况。结果：实验组治疗3个月后的有效率明显高于对照组,差异有统计学意义（P〈0．05）。治疗6个月后,实验组和对照组的有效率较治疗3个月后均提高,但差异不明显。实验组治疗6个月后的有效率仍高于对照组,但差异无统计学意义（P〉0．05）。停用后随访,实验组的复发率明显低于对照组（P〈0．05）。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,二者联用疗效优于单独应用伊曲康唑疗效,两种药物从不同途径抗真菌,不良反应少,复发率低,值得广泛推广。     

Itraconazole compared with griseofulvin in the treatment of tinea corporis/cruris and tinea pedis/manus: an interpretation of the clinical results of all completed double-blind studies with respect to the pharmacokinetic profile.

Itraconazole is an orally active triazole antifungal which has been compared to griseofulvin in a number of double-blind trials. In dermatophytosis with a non-fixed treatment regimen for a maximum of 3 months, itraconazole 100 mg o.d. has produced a 100% mycological cure rate as compared with a 67% rate with griseofulvin 500 mg o.d. (p less than 0.01). Based on the pharmacokinetic profile, 100 mg itraconazole daily was then compared with 500 mg ultramicronized griseofulvin daily using a fixed treatment schedule of 15 days in tinea corporis and/or cruris and 30 days in tinea pedis and/or manus. In all studies in tinea corporis/cruris (n = 277), the superiority of itraconazole was shown for the clinical outcome at the last follow-up visit 2 weeks post-therapy (88 vs. 69%, p less than 0.01) and in the mycological outcome at the last follow-up visit (81 vs. 65%, p less than 0.05). In tinea pedis/manus (n = 210), the clinical response was virtually the same for the two treatment groups, but the most important finding was the mycological outcome with a significantly better result in favor of itraconazole at the end of treatment (77 vs. 61%, p less than 0.05) even more pronounced at the follow-up visit (85 vs. 48%, p less than 0.01). We conclude that itraconazole 100 mg daily in the treatment of tinea corporis/cruris and in tinea pedis/manus is significantly more effective than 500 mg griseofulvin daily when fixed treatment regimens are used. Furthermore, the best results are obtained with itraconazole 2-3 weeks after the end of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

伊曲康唑、氟康唑与特比萘芬联合治疗肺隐球菌病1例

采用伊曲康唑、氟康唑与特比萘芬联合治疗1例肺隐球菌病。患者男,48岁。发热、咳嗽、右肺部出现大片阴影27d。经皮肺穿刺活检,确诊为肺隐球菌病。给予氟康唑150mg／a、特比萘芬250mg／a口服治疗,1个月后复查胸部X线片及CT,肺部病变明显好转,但随后恢复较慢,改用伊曲康唑200mg／a联合特比萘芬250mg／d口服治疗3个月后,肺部阴影完全消失。     

特比萘芬和伊曲康唑治疗原发性皮肤曲霉病2例疗效观察

分别应用特比萘芬、伊曲康唑治疗2例皮肤曲霉病,并对其治疗前后真菌学和组织病理改变进行对比观察。例1,男,38岁,躯干部出现多发性坏死性溃疡2个月。通过真菌学、组织病理和扫描电镜观察确诊为黄曲霉所致原发性皮肤曲霉病。口服特比萘芬,500mg/d,治疗4周后治愈。例2,女,28岁,双手背、左跟腱部发生数个结节及坏死性溃疡8个月。实验室检查方法和诊断基本同例1。给予伊曲康唑口服,400mg/d,5周后显著好转,将剂量减至200mg/d,维持治疗至3个月后临床痊愈。例1、例2于治疗后做真菌分离培养均未见生长,组织病理复查病灶亦无真菌。     

重组人粒细胞巨噬细胞集落刺激因子与伊曲康唑联合对白念珠菌抗菌作用的实验研究

目的 研究重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)与伊曲康唑联合抗白念珠菌的作用。方法 体内实验:制备系统性白念珠菌感染小鼠模型,用不同剂量伊曲康唑单独或与rhGM-CSF联合应用于感染小鼠,观测其28d内的存活情况。体外实验:分离鼠外周血中性粒细胞及腹腔巨噬细胞,分别将其与不同浓度的伊曲康唑及伊曲康唑加rhGM-CSF与白念珠菌共同培养,通过计数菌落形成单位(cfu)来判定伊曲康唑单独或与rhGM-CSF联合应用的抗白念珠菌效果。结果 伊曲康唑1.0mg/kg与rhGM-CSF25μg/kg联合应用能显著延长小鼠28d内的存活期,效果与单用伊曲康唑2.5mg/kg相等,而rhGM-CSF25μg/kg与伊曲康唑5mg/kg联合应用时效果相当于单用伊曲康唑10mg/kg。体外实验亦显示rhGM-CSF与伊曲康唑联用能减少白念珠菌数量。结论 rhGM-CSF与伊曲康唑联合应用对抗小鼠系统性白念珠菌感染有较好的协同作用。     

Extensive and deep dermatophytosis caused by Trichophyton mentagrophytes var. Interdigitalis in an HIV-1 positive patient

BACKGROUND: Cutaneous infections are common in HIV-1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients. OBJECTIVE: We report a case of an HIV-1-positive 23-year-old male, with a history of intravenous drug use, in stage C-II (CDC '86), with a CD4 lymphocyte count of 335 cells/mm3. He had multiple, large erythematous, circinate and pustular plaques on his abdomen, back, arms and legs. RESULTS: We isolated Trichophyton mentagrophytes var. interdigitalis from the lesions. The biopsy showed suppurative deep dermatophytosis and folliculitis. The patient satisfactorily responded to itraconazole (100 mg/d for 14 days). CONCLUSION: This is the first reported case of deep dermatophytosis caused by T. mentagrophytes in an HIV-positive patient.     

口服特比萘芬与伊曲康唑治疗儿童头癣的疗效比较

目的比较口服特比萘芬与伊曲康唑治疗儿童头癣的疗效。方法 2021年1-12月北京儿童医院皮肤科门诊头癣患儿53例, 采用随机数字表法分为特比萘芬治疗组(体重< 20 kg, 剂量62.5 mg/d;体重20 ～ 40 kg, 剂量125 mg/d;体重> 40 kg, 剂量250 mg/d)和伊曲康唑治疗组(3 ～ 5 mg·kg-1·d-1)。使用SPSS23.0软件进行统计分析, 组间计数资料比较采用χ2检验或Fisher确切概率法。结果特比萘芬治疗组27例(白癣17例、脓癣10例), 治愈14例(51.85%), 其中白癣5例, 脓癣9例。伊曲康唑治疗组26例(白癣17例、脓癣9例), 治愈25例(96.15%), 其中白癣16例, 脓癣9例。伊曲康唑组的疗效显著高于特比萘芬组, χ2 = 13.37, P < 0.001。结论伊曲康唑治疗儿童白癣的效果优于特比萘芬, 但两药治疗儿童脓癣的疗效相当。     

对唑类药物交叉耐药的烟曲霉临床分离株耐药机制的初步探讨

目的 研究对唑类药物交叉耐药的烟曲霉临床分离株的耐药机制。方法 自1例侵袭性曲霉病患者体内分离得到1株烟曲霉,分别利用美国临床实验室标准化研究所（CLSI）M38-A2中的微量液基稀释法和E-test法测定伊曲康唑、伏立康唑、两性霉素B、泊沙康唑和卡泊芬净对该烟曲霉的最低抑菌浓度（MIC）/最低有效浓度（MEC）;并对该菌株中唑类药物靶酶基因cyp51A进行克隆和序列测定分析。结果 微量液基稀释法显示,该菌株伊曲康唑、伏立康唑、两性霉素B的MIC分别为≥16、8、1 mg/L,卡泊芬净的MEC为0.5 mg/L。E-test法显示,伊曲康唑、伏立康唑、两性霉素B和泊沙康唑的MIC分别为≥32、≥32、12和≥32 mg/L,卡泊芬净的MIC为0.047 mg/L。对cyp51A基因进行测序并分析后发现,该菌株的cyp51A序列中存在启动子区-288到-322位间34 bp的串联序列的插入,以及该基因编码区364位碱基的点突变（T364A）,导致了编码区98位亮氨酸的置换（L98H）;该菌株的cyp51A基因编码区还存在137位碱基（A137T）、585位碱基（G585A）、814位碱基（C814A）、836位碱基（G836C）、991位碱基（T991C）、1350位碱基（A1350G）的突变,并分别导致编码区相应氨基酸的置换。结论 分离到对唑类药物交叉耐药的烟曲霉临床株,该菌株的cyp51A基因存在启动子区34 bp的串联序列插入和编码区364位的突变（T364A）,这种变化参与了其对伊曲康唑、伏立康唑和泊沙康唑交叉耐药;该菌株cyp51A基因编码区还存在一些其他的点突变,并可导致相应部位的氨基酸置换。     

Double-Blind Comparison of Itraconazole with Griseofulvin in the Treatment of Tinea Corporis and Tinea Cruris

Seventy-eight patients with tinea corporis or tinea cruris participated in a double-blind study with either 100 mg itraconazole or 500 mg ultramicronized griseofulvin for 15 consecutive days. Clinical outcome was significantly in favor of itraconazole at completion of treatment (72% response rate vs. 51%) and at the follow-up visit (91% response vs. 64%). The most important difference between both treatments was the mycologic outcome, for which itraconazole showed a cure rate of 87% compared to 57% for griseofulvin 2 weeks after completion of therapy. It is suggested that 100 mg of itraconazole orally once daily is significantly more effective than 500 mg of griseofulvin once daily for 15 days in the treatment of glabrous skin infections. Both drugs were well tolerated.     

Itraconazole in the treatment of superficial mycoses—a double-blind study vs. placebo

Ninety-four patients with dermatophytosis and 16 patients with pityriasis versicolor were assigned under double-blind conditions to oral itraconazole (100 mg once daily) or placebo. The medication consisted of two capsules, each containing 50 mg of active substance, or placebo and was given for 15 or 30 days in patients with dermatophytosis and for 15 days in patients with pityriasis versicolor. Patients with pityriasis versicolor who had not responded at the end of the double-blind period were treated on an open basis with itraconazole (100 mg once daily) for 15 days. In the treatment of dermatophyte infections for 30 days, both clinical response and mycological cure were significantly superior in the itraconazole group compared with placebo. Oral administration of itraconazole (100 mg once daily) was also highly efficacious in the treatment of pityriasis versicolor. None of the placebo patients was clinically or mycologically cured at the end of the double-blind phase compared to seven out of eight itraconazole patients. All placebo patients who entered the open phase responded to itraconazole treatment. Three itraconazole-treated patients and nine placebo-treated patients reported side-effects.