假丝酵母菌药敏实验及影响药物敏感性的因素分析

目的了解深圳地区育龄妇女外阴阴道假丝酵母菌的耐药情况及药物敏感性,探讨影响其药物敏感性的因素,为外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）的治疗提供参考依据。方法从体检妇女人群中阴道分泌物培养念珠菌感染阳性病例中选择103例为研究对象,对样本采用氟康唑、两性霉素B、伊曲康唑、酮康唑、益康唑进行药物敏感性实验;并回顾性调查检测对象病史、用药情况等。结果研究对象平均年龄（36.16±6.72）岁,文化程度以初中、高中和大专为主,分别占14.3%、29.7%和52.0%。对5种药物都敏感的样本有55例,占53.5%,对1种以上药物不敏感的样本有48例,占46.5%。药物敏感性依次是：两性霉素B（97.0%）、酮康唑（94.2%）、伊曲康唑（92.2%）、氟康唑（80.6%）、益康唑（72.8%）。近期使用抗生素更加容易使菌株对伊曲康唑和益康唑产生不敏感。使用抗生素的对象对两性霉素B、伊曲康唑、益康唑的耐药率分别为7.1%、14.3%和35.7%;而没有使用抗生素的对象对两性霉素B、伊曲康唑、益康唑的耐药率分别为2.3%、6.7%和25.8%。反复感染者的样本对两性霉素B（100.0%）和酮康唑（100.0%）非常敏感,但是会增加对伊曲康唑（8.7%）和益康唑（30.4%）的不敏感性。结论深圳地区外阴阴道假丝酵母菌整体耐药性较少,但近期使用抗生素和反复感染者对药物的敏感性有影响。临床治疗宜首选两性霉素B和酮康唑,反复感染者建议联合用药治疗。

The Drug Sensitivity Study for Candida and Factor Influence Factor of Drug Sensitivity

Objective To investigate the incidence of female vulvovaginal candidiasis in Shenzhen area,candidiasis drug sensitivity;and the influence factors of the drugs sensitivity for the vulvovaginal candidiasis（VVC）,as a treatment reference of vulvovaginal candidiasis in Shenzhen area.Methods The object of study had selected 103 vaginal secretion samples were collected from women who were positive in vulvovaginal candidiasis test.These samples had got from woman physical examination center.All the samples did five drugs（fluconazole,amphotericinB,itraconazole,ketoconazole,econazole） sensitivity test.It retrospective reviewed the VVC cases medical history and medications.Results（1） The mean age of these women is 36.16±6.72 years old and the education level of them is 14.3% junior high school level,29.7% senior high school level and 52.0% technical secondary level.（2） 55 samples were sensitive to all five drugs（53.5%）;48（46.5%）samples became desensitized to one drugs or more.The order of the sensitivity for high level to low level in the five drugs is： amphotericin B（97.0%）,ketoconazole（94.2%）,itraconazole（92.2%）,fluconazole（80.6%）,econazole（72.8%）.（3） Using antibiotics recently could make the VVC insensitive to itraconazole and econazole.7.1% of the samples which had used antibiotics became insensitivity to amphotericin B,14.3% of it became insensitivity to itraconazole,and 35.7% of them became insensitivity to econazole.The percentages of the samples which had not used antibiotics and which became insensitivity to amphotericin B,itraconazole and econazole are 2.3%,6.7% and 25.8%,respectively.（4） The VVC repeated infection samples were more sensitive to amphotericin B（100.0%） and ketoconazole（100.0%） than the first time of infection,but the repeated infection samples were insensitive to itraconazole（8.7%） and econazole（30.4%）.Conclusion The overall drug resistance in females with VVC in Shenzhen is low.Using antibiotics recently and repeated infection can affect the drug sensitivity.Amphotericin B and ketoconazole are the preferred drugs for treatment.We suggest using combination of drugs to treat the VVC of repeated infection.