头颈部肿瘤术后放疗患者口腔假丝酵母菌感染检测

Oral Colonization of Candida Species in Patients Received Radiotherapy in the Head and Neck Area

目的对头颈部放疗患者口腔假丝酵母菌进行定性和定量检测。方法选择29名头颈部放疗患者、29名老年精神科住院患者以及34名正常老年志愿者做为研究对象。在第10次放疗结束收集唾液样本,假丝酵母菌显色培养基(CHROMagar)进行分离、培养、鉴定和菌落计数。结果 92名受试者中,51(55.4%)人假丝酵母菌检出率为阳性,而在放疗组和老年科住院患者组检出率为58.6%,明显高于正常老年对照组(P=0.334)。假丝酵母菌检出率与临床假丝酵母菌感染(P=0.031)、口干症(P=0.007)有关,与性别因素无明显相关(P=0.334)。CHROMagar显色培养结果显示,感染菌群为白色假丝酵母菌、杜氏假丝酵母菌、热带假丝酵母菌、克柔假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌、季力蒙假丝酵母菌、葡萄牙假丝酵母菌、乳酒假丝酵母菌。其中以白色假丝酵母菌最为常见,其次为热带假丝酵母菌、近平滑假丝酵母菌、光滑假丝酵母菌。老年对照组和老年科住院患者组中,白色假丝酵母菌为主要菌群,检出率分别为45.0%和41.2%;放疗组主要检出菌群为热带假丝酵母菌(27.0%),其次为白色假丝酵母菌(16.2%)、近平滑假丝酵母菌(16.2%)。多变量统计分析发现,仅放疗与口腔假丝酵母菌感染相关。结论头颈部放疗患者由于口腔内环境的改变,容易出现口腔假丝酵母菌感染,并呈现出菌群多样性以及非白色假丝酵母菌为主感染状态。

Obiective To identify and quantify Candida on head and neck irradiated patients with two comparative elderly populations.Methods Twenty Nine head and neck irradiated patients （group 1） were included,and 34 noninstitutionalized elderly patients （group 2） and 29 institutionalized elders （group 3） were as control groups.Saliva was sampled during 10th to the end of radiotherapy,and then sewed on CHROMagar culture for identification and quantification of candida.Results Among the 92 patients surveyed,51 （55.4％） had scores classified as positive for Candida,and among individuals of groups 1 and 3,58.6％ had Candida.There was higher positive/carrier conditions （CFU/sample） in groups 1 and β,compared with group 2 （P =0.011）.Gender was not associated with Candida portability （P =0.334）.Candida portability was significantly associated with the presence of candidosis （P =0.031） and xerostomic state （P =0.007）.The isolates and definitive confirmed colonies were Candida albicans,Candida dubliniensis,Candida tropicalis,Candida krusei,Candida glabrata,Candida parapsilosis,Candida guilliermondii,Candida lusitaniae,and Candida kefyr.Among the species identified,C.albicans was the most frequent,followed by C.tropicalis,C.parapsilosis and C.glabrata.C.albicans was more prevalent in group 2 and 3,45％ and 41.2％,respectively,whereas,the most prevalent species in group 1 were C.tropicalis （27％）,C.albicans and C.parapsilosis （16.2％ for both）.On multiple statistical models,only radiotherapic treatment was associated with positiveness to Candida.Conclusion Diversification and major prevalence of non-albicans species were observed in irradiated patients on head and neck and this treatment is straightly associated with fungus positiveness.