【作者】 李平；

【导师】 祁红；

【作者基本信息】 上海交通大学 ， 基础医学， 2018， 硕士

【摘要】 头状地霉(亦称头地霉)所致的肺部感染是一种非常罕见的系统性真菌感染疾病,全世界仅有一百多例病例报道,且目前没有统一规范的治疗方法。中国国内仅有三例报道,且疗效尚不确切。本研究基于作者在临床药学工作实践中遇到的一例罕见头状地霉菌感染病例,作者通过参与制定治疗方案,并进行体外药敏研究,对抗真菌感染的疗程进行了临床实践探索。目前,我国尚未有关头状地霉菌的药敏特性的研究报道。本研究通过对患者痰液标本分离得到的菌株进行培养,分别使用了微量稀释法和琼脂扩散法测定头状地霉的最小抑菌浓度以及抑菌圈的形态特征,并且对两种方法的一致性进行了初步评价,为我国头状地霉菌的抗感染治疗提供了体外药敏数据。为了进一步探索药物联用的效果,本研究通过联合药敏试验将抗真菌药物氟胞嘧啶及氟康唑按不同的浓度梯度排列组合,进行了联合药敏试验并测定了部分抑菌浓度指数(亦称分级抑菌浓度指数,fractional inhibitory concentration,FIC),从而为制定合理的抗真菌药物的联用方案提供了必要的实验依据。综上,本课题首次尝试使用氟胞嘧啶联合氟康唑治疗方案,研究证实该方案可有效治疗头状地霉菌肺炎,为了彻底治愈感染、避免感染复发,其抗感染疗程应不少于2个月。微量稀释法和琼脂扩散法的体外药敏试验结果相似,且与临床疗效相吻合。体外联合药敏也验证了氟胞嘧啶联合氟康唑方案的疗效,该药物联用方案可以作为头状地霉菌肺炎推荐治疗方案。更多还原

【Abstract】 Geotrichum Capitatum pneumonia is a very rare systemic fungal infection diease.Up to now,only a hundred caseswere reported worldwide,among whichthree cases were reported in China.There isno available standard effective therapy of Geotrichum Capitatum pneumonia.This research is based on a true case of Geotrichum Capitatum infection from clinical pharmacist daily work.By attending the therapy and the following in vitrosusceptibility studies,the author explored the course of the treatment in the clincal practice.As there is no availablein vitro susceptibility test reported of Geotrichum Capitatumis in China,this study will culture the strain which is separated from the patient’s sputum.Then,the author measured the MIC(minimal inhibitory concentration)value by microdilution method and the diameter of inhibition zone by AGAR diffusion method.The consistency of two methods was evaluated as well.The study contributes valuable in vitro susceptibility data for the therapy of Geotrichum Capitatum infection.The study also evaluates the effect of drug combination according to concentration gradient,and calculates the FIC(fractional inhibitory concentration)index,which will provide necessary data support for antifungal agent combination.In conclusion,the combination of flucytosine and fluconazole were effective to treat Geotrichum Capitatum pneumonia.In order to cure completely and avoid relapse,the anti-infection treatment should not be less than 2 months.The in vitro susceptibility test results of the microdilution method and AGAR diffusion method are identical,and consistent to patient’s clinical outcome.The efficacy of the combination of flucytosine and fluconazolewas validated byin vitro susceptibility test.The combination of flucytosine and fluconazole can be recommended as an optimized treatment for Geotrichum Capitatum pneumonia.更多还原