甲真菌病患者真菌感染情况及机体免疫状况分析

Analysis of the prevalence of a mycotic infection in patients with onychomycosis and their immune status

目的分析甲真菌病病原菌的菌种构成、分布特点及其与甲真菌病临床类型的关系,探讨机体免疫对甲真菌病发生的影响。方法采集332例真菌镜检阳性的甲真菌病患者甲标本进行真菌培养,对真菌培养阳性的患者进行临床分类,分析不同临床类型患者甲真菌病病原菌构成;以200例体检健康者为对照,对甲真菌病患者和健康者进行外周血T淋巴细胞亚群及血清免疫球蛋白水平检测,分析甲真菌病患者的免疫水平。结果 332例患者中,真菌培养阳性215例,阳性率64.8%。其中皮肤癣菌属占74.9%(161/215),酵母菌属占20.5%(44/215),霉菌属占4.7%(10/215)。红色毛癣菌合并白念珠菌感染6例,占2.8%;红色毛癣菌合并青霉菌感染3例,占1.4%。215例真菌培养阳性患者的主要临床类型为远端侧缘甲下型(DLSO),占47.0%(101/215)。与健康者比较,甲真菌病患者外周血CD3+、CD4+百分率及CD4+/CD8+比值降低(P<0.05),CD8+百分率升高(P<0.05),血清IgG、IgA、IgM水平下降(P<0.05),以真菌培养阳性患者变化更显著(P<0.05)。结论甲真菌病的优势病原菌为皮肤癣菌,该病的常见临床类型为DLSO。甲真菌病患者免疫功能下降,提示机体免疫状况对甲真菌病的发生有一定影响。

Objectives To investigate the composition and distribution characteristics of the pathogens causing onychomycosis,to analyze their relationship to the clinical types of onychomycosis,and to examine the effects of onychomycosis on the immune system. Methods Specimens from 332 patients with onychomycosis were cultured,and patients with a positive fungal culture were categorized based on clinical types of onychomycosis.Pathogens causing onychomycosis were identified in different clinical categories.Two hundred healthy persons served as controls,and T-lymphocyte subsets in peripheral blood and serum immunoglobulin levels were determined in patients with onychomycosis and healthy persons.The immunity of patients with a fungal disease was analyzed. Results Of 332 patients with onychomycosis,215（64.8%）had a positive fungal culture.Of those 215 patients,74.9%（161/215）were infected with dermatophytes,20.5%（44/215）were infected with yeast,and 4.7%（10/215）were infected with mold.A mixed infection was noted in9 patients,which consisted of 6 patients（2.8%）infected with Trichophyton rubrum and Monilia albicans and 3 patients（1.4%）infected with Trichophyton rubrumand Penicillium.The leading clinical type of onychomycosis was distal lateral subungual onychomycosis（DLSO）,which was noted in 47.0%（101/215）of patients with a positive fungal culture.Compared to healthy persons,patients with onychomycosis had a significantly lower level of CD3＋and CD4＋T-lymphocytes in peripheral blood and a lower ratio of CD4＋/CD8＋T-lymphocytes（t=29.870,33.245,62.603,P〈0.05）.Patients with onychomycosis had a significantly higher level of CD8＋T-lymphocytes（t=6.330,P〈0.05）.The levels of serum immunoglobulin G（IgG）,IgA,and IgM in patients with onychomycosis were markedly lower than those in healthy persons（t=5.360,57.445,30.025,P〈0.05）.Furthermore,changes in the ratios of T-lymphocyte subsets in peripheral blood and serum immunoglobulin levels were more marked in patients with a positive fungal culture than in patients with a negative fungal culture（t=18.050,14.406,10.447,3.590,2.055,14.114,8.873,P〈0.05）. ConclusionDermatophytes are the dominant pathogens causing onychomycosis,and DLSO is the leading clinical type of onychomycosis.Patients with onychomycosis had decreased immune function,suggesting that immune status has some effect on the pathogenesis of onychomycosis.