天津地区4100例甲真菌病致病菌流行特点及病甲形态与致病菌关系的分析

Analysis of Etiologic Characteristics and Relationship between the Morphological Featuress and Pathogenic Fungi in 4100 Cases of Onychomycosis in Tianjin

目的了解天津地区甲真菌病致病菌流行趋势及病甲形态与致病菌的相关性。方法对本院皮肤科门诊就诊的4 100例甲真菌培养结果阳性患者的临床资料、真菌培养结果等进行统计与分析。结果共分离菌株4 625株,其中皮肤癣菌2 998株(64.82%),以红色毛癣菌为主,共2 422株(80.79%);酵母菌1 309株(28.30%),以白念珠菌为主,共1 099株(83.96%);其他(包括曲霉、短掃霉等)318株(6.88%)。在临床分型上主要以远端侧位甲下型(DLSO)为主。远端侧位甲下型、白色浅表型(SWO)主要由皮肤癣菌感染引起,全甲营养不良型(TDO)、近端甲下型(PSO)主要由酵母菌感染引起。皮肤癣菌感染时病甲多呈黄色或黄褐色,一般无绿、黑色等特殊改变,酵母菌感染时病甲可呈黄色或黄褐色,但亦可见绿、黑色等特殊改变。结论与天津地区既往研究相比较,红色毛癣菌仍为优势致病菌,但比例有所下降,酵母菌的比例升高。根据病甲的临床分型、形态学变化、颜色改变可以大致推断致病菌的种类。

Objective To learn the trends about pathogens of onychomycosis （OM） in Tianjin and the relationship be- tween the morphological features of involved nail and pathogenic fungi in onyehomycosis. MethodsFungal cul- ture and clinical analysis were performed on 4 100 cases of onychomyeosis with positive fungal cultivation. Results A total of 4 625 strains of pathogenic fungi were identified. Amongst them, 2 998 strains （64. 82% ） were dermatophytes, the most frequently isolated fungus. Majority was Amongthemuyj and 2 422 strains （80. 79% ） were Trichophyton rubrum. The 1 309 strains （28. 30% ） were yeasts. Among those, 1099 strains （83.96%） were Candida albicans and 318 （6. 88% ）were others. The most frequent clinical patterns were DLSO. The main pathogens of onyehomycosis in DLSO and SWO were dermatophytes. The main pathogens of onyehomycosis in TDO and PSO were yeasts. The nails were mainly yellow and tan infec- ted by dermatophytes. However, both yellow and green or black can be seen when the nails infected by yeasts. Conclusion Compared with previous studies in Tianjin, the proportion of Trichophyton rubrum was declined and yeast was increased. According to the clinical types, morphological features and color changes of involved nail, we can roughly infer the pathogenic fungi.