某社区医院甲真菌病临床类型和致病真菌的研究

Sudy on Clinical Patterns and Pathogenic Fungi of Onychomycosis in A Community Hospital

目的分离和调查某社区医院甲真菌病的致病真菌和临床类型。方法自2005年1月～2007年8月,对306例甲真菌病患者的病甲进行致病真菌分离,将取材物进行KOH显微镜检查和真菌培养。记录每位患者的病史资料,分析致病真菌分布与各因素之间的关系,临床类型与致病真菌之间的关系。结果306例中足趾甲感染占62.1%,手指甲感染占9.5%,手足指趾甲混合感染占28.4%。远端侧缘甲下型(DLSO)是最常见的一种临床类型,有195例患者(63.7%),其次是全甲破坏型(TDO)(82例;26.8%),无甲沟炎的近端甲下型(PSO)(18例;5.9%),合并甲沟炎的近端甲下型(PSO)(8例;2.6%),浅表白甲型(SWO)(3例;0.98%)。DLSO与其他临床类型相比显著增多(P<0.001)。306株致病真菌中主要为皮肤癣菌(68.0%),其中80.3%为红色毛癣菌;酵母菌22.5%,其中73.9%为白念珠菌;第三位是霉菌(9.5%),主要为曲霉。结论发现该社区医院甲真菌病常见的临床类型为DLSO和TDO,而PSO和SWO不常见。致病病原菌以红色毛癣菌和白念珠菌为主。临床类型和病原学关系显示单一致病真菌可以引发一种以上类型的甲真菌病。

Objective To determine the causative pathogens and the various clinical patterns of onychomycosis in a community hospital. Methods To isolate the causative fugi from nail samples of 306 patients with onychomycosis during the period of January 2005 to August 2007. Material from the affected nails was obtained for KOH microscopic examination and culture. A history of onychomycosis from each patient was recorded. The association between various factors and the distribution of pathogens was analysed. Clinical patterns of onychomycosis were noted and correlated with causative pathogens. Results 62.1% patients had toe- nail involvement alone, while 9.5 % had fingernail involvement alone. 28.4% patients had both fingernail and toenail involvement. Distolateral subungual onychomycosis was the most common clinical type, being encountered in 195 patients （63.7%） ,followed by total dystrophic onychomycosis （82 patients;26.8% ）, proximal subungual onychomycosis without paronychia （18 patients; 5.9% ）, and proximal subungual onychomycosis with paronychia（8 patients; 2.6% ）, superficial white onychomycosis （three patients; 0, 98%）. 306 strains of pathogens were isolated, of which mostly were dermatophytes （68.0 % ）, such as T. rubrum （80.3%） ,yeasts（22.5% ） ,and C. albicans（ 73. 9% ）. Nondermatophyte molds were at the third（9, 5 % ） , most were Aspergillus spp. Conclusions Distolateral subungual onychomycosis and total dystrophic onychomycosis were the common clinical Presentation; however, proximal subungual onychomycosis and superficial white onychomycosis were not uncommon in this community hospital. Tricophyton rubrum and Candida albicans were the major pathogens. The clinicoetiologic correlation revealed that a single pathogen could give rise to more than one clinical type.