【作者】 王华； 杨国玲； 韩世新； 宋智琦； 唐立；

【机构】 大连医科大学附属第一医院皮肤科；

【摘要】 目的：通过对皮炎湿疹患者皮肤几种常见细菌、真菌的检测并与正常皮肤寄生菌进行对比,探讨皮损微生物感染种类,数量与皮炎湿疹类疾病的关系,为临床皮炎湿疹患者皮损治疗提供依据。方法：筛选日于皮炎湿疹患者皮损部位和对应的非皮损部位同时取材做细菌、真菌培养,对培养结果进行常规菌种鉴定和菌落计数,并用生化试验和形态学方法对马拉色菌属进行种的鉴定。结果： 1．皮炎湿疹患者皮损与非皮损部位细菌、真菌检出情况：90例皮炎湿疹患者皮损细菌总阳性率为67．78%,金黄色葡萄球菌检出率为31．11%。马拉色菌检出率为47．78%均明显高于非皮损部位及健康人正常皮肤,但三者表皮葡萄球菌检出率无明显差异。并且金黄色葡萄球菌感染皮损中马拉色菌的检出率明显高于非金黄色葡萄球菌感染皮损部位。 2．临床症状与细菌、真菌感染的关系：急性渗出型皮损细菌总检出率和平均密度显著高于慢性斑块型皮损,而二者金黄色葡萄球菌及马拉色菌检出率均无显著性差异。继发感染患者皮损细菌总检出率及金黄色葡萄球菌检出率均显著高于临床无感染的皮炎湿疹患者,而马拉色菌检出率均无显著性差异． 3．马拉色菌属种的鉴定：皮炎湿疹患者皮损中主要为糠秕马拉色菌,占51．16%,其次为球形马拉色菌和合轴马拉色菌,均占13．95%,厚皮马拉色菌和限制性马拉色菌最少。结论： 1．本研究显示湿疹皮炎患者皮损部位微生物的感染及定植密度与疾病的发生、发展和严重程度密切相关．即当皮损部位金黄色葡萄球菌及马拉色菌感染增加时,湿疹皮炎的炎症反应明显加重,且常表现为急性渗出型皮损． 2．研究发现皮损部位糠秕马拉色菌和球形马拉色菌的感染增加与皮炎湿疹类疾病的各临床病型之间存在密切关系。 3．经上述研究推断临床治疗中严格控制微生物感染的种类和数量,合理应用抗生素可能对皮炎湿疹临床症状的改善有效。更多还原

【Abstract】 Objective:To investigate the colonization of bacteria and fungus in the lesion of the patients with eczematous dermatitis,to evaluate the relation between microorganism infection and eczematous dermatitis,and to provide the basis of the rational use of antimicrobial agents clinically. Methods:Samples of bacterial and fungus were obtained from the lesions,non-lesions of 90 patient and normal skin and were examined by culture and quantitative assessment of the density.Identification of Malassezia spacies was taken by physio-biochemics approach. Results:The culturally positive rate of bacterial colonization was 67.78% on the skin lesions of eczematous dermatitis,and Staphylococcus aureus was overwhelmingly the dominant species accounting for 31.11%.The positive rate of Malassezia colonization was 47.78% on the skin lesions.Bacteria and fungus were also isolated from the non-lesions in these patient.However,there were statistical differences in the positive rate of the culture,the ratio and the colonization,that the positive rate of Staphylococcus aureus and Malassezia and the density of Staphylococcus aureus were much higher on the skin lesions than that on the non-lesions in eczematous dermatitis patient.Moreover,the amount of bacteria colonized,especially Staphylococcus aureus was markedly higher in the lesional skin with secondary infections than that without secondary infections. The lesional skin of eczematous dermatitis had a higher rate of carrying Malassezia furfur and Malassezia globosa than others,which imply that Malassezia may have some relations with some eczematous dermatitis. Conclusion:The infection of Staphylococcus arueus and Malassezia may play an important role as an aggravating factor in pathogenesis of eczematous dermatitis.And early application of topical antibiotics is beneficial to the patient.更多还原