头颈部放化疗后口腔假丝酵母菌耐药性分析及抗真菌中药筛选

Antifugal Susceptibility Testing and Antifugal Traditional Chinese Medicines Screening of Oral Candida Isolated from Head and Neck Cancer Patients Treated with Radiotherapy or Chemotherapy

目的研究头颈部放化疗患者口腔假丝酵母菌感染菌株的种类及耐药性,并依据美国国家临床实验室标准协会(NCCLS)的M27-A2标准方案筛选抗真菌中药。方法采集头颈部放化疗患者口腔假丝酵母菌感染的临床分离菌株20株,经YBC Test Kit鉴定假丝酵母菌种类;依据NCCLS的M27-A2标准方案测定其对5-氟胞嘧啶、氟康唑、伊曲康唑、6种中药提取物(蒺藜、金银花、蒲公英、绿茶、松树皮、红三叶草提取物)及7种中药有效成分(苦参碱、苦豆碱、大黄素、甘草酸、白芍总苷、黄芩苷、盐酸小蘖碱)的药物敏感性。结果 20株放化疗患者口腔假丝酵母菌感染菌株中非白假丝酵母菌5株,对5-氟胞嘧啶全部敏感,对氟康唑和伊曲康唑的耐药比例分别为25％和40％;白芍总苷和盐酸小蘖碱具有抗假丝酵母菌活性。结论头颈部放化疗患者口腔假丝酵母菌感染菌株中非白假丝酵母菌比例及对氟康唑和伊曲康唑的耐药比例较高;白芍总苷和盐酸小蘖碱是有临床应用前景的抗口腔假丝酵母菌药物;依据NCCLS的M27-A2标准方案筛选抗真菌中药是一种准确有效的方法。

Objective To evaluate the sensitivity and resistance of pathogenic oral Candida spp. isolated from head and neck cancer patients treated with radiotherapy or chemotherapy to antifungal agents. To screen antifugal agents from Chinese traditional and herbal drugs by NCCLS M27-A2 method. Methods Using YBC Test Kit to identify 20 clinical oral Candida isolated from head and neck cancer patients treated with radiotherapy or chemotherapy. The in vitro susceptibilities of 20 oral Candida spp. to 5-flucytosine（5-FC）, itraconasole（ITB）, fluconazole （FLU）, the extracts of 6 Chinese traditional and herbal drugs （caltrop, honeysuckle flower, dandelion, green tea, pine bark, red trefoil） and utility componets of 7 Chinese traditional and herbal drugs （sophorcarpidine, aloperine, archin, glycyrrhizic acid, glycosides of white peony root, glycosides of baikal skullcap root, hydrochloric berberine）were determined by NCCLS M27-A2 method. Results The proportion of no-C.albicans in all Candida spp. were 25%. All strains were sensitive to 5-flucytosine, 25% stains were resistant to fluconasole and 40% stains were resistant to itraconazole. In all agents from Chinese traditional and herbal drugs, glycosides of white peony root and hydrochloric berberine （C20H18CINO4） exhibited antifungal activity, especially to C. glabrates. Conclusion The proportion of no-C.albicans in all oral Candida spp. isolated from head and neck cancer patients treated with radiotherapy or chemotherapy was pretty high. NCCLS M27-A2 micro-dilution method is a reliable and reproducible method and can be used to screen antifugal agents from Chinese traditional and herbal drugs.