特应性皮炎皮损微生物与外用药对比治疗研究

Study on Microbes on Skin Lesions and a Controlled Topical Treatment Trial in Atopic Dermatitis

目的研究特应性皮炎（<.）皮损微生物感染、金黄色葡萄球菌=金葡菌>耐药与外用药的疗效。方法#$$%年%%月至#$$#年&月在北京中日友好医院及北京市儿童医院皮肤科门诊，按照?2,+@+,AB2CD2诊断标准，共诊断<.患者"%例。治疗前后于皮损处取材进行真菌直接镜检、真菌培养、细菌培养及药敏试验，以E)FB<.方法计分，将其中((例患者随机分成两组，分别采用%G硝酸益康唑H$;%G曲安奈德霜与$;%G丁酸氢化可的松软膏外用对比治疗<.患者。结果<.患者以婴幼儿、儿童为主=&%#岁者占"&;#!G>；皮损细菌培养阳性率为'&;'%G=金葡菌阳性率为&';#%G>，真菌阳性率为%;!%G；药敏结果显示金葡菌对利福平、万古霉素、丁胺卡那霉素、环丙沙星、头孢唑啉、头孢呋辛等敏感性好；%G硝酸益康唑H$;%G曲安奈德霜与$;%G丁酸氢化可的松软膏外用治疗<.!周时，前者疗效优于后者（!I$;$'），细菌阴转率前者高于后者（!I$;$%）。两组外用药治疗的患者均未见不良反应。结论具有抗感染与抗炎双重作用的%G硝酸益康唑H$;%G曲安奈德霜治疗<.的疗效优于$;%G丁酸氢化可的松软膏。

Objective To study microbial flora on skin lesions and their antim icrobial susceptibilities and to conduct a topical treatment trial in atopic der matitis (AD). Methods Seventy one patients with AD were diagnosed according to the criteria of Hanifin-Rajka′s in departments of dermatology in China-Japan Friendship Hospital and Beijing Children Hospital during November,2001 to March, 2002. Bacteria and fungi were examined by culture and microscopy. Among 71 case s, 66 were divided into two groups randomly with one group receiving 1%econazol e+0.1%triamcinolone acetonide cream topically twice daily for 4 weeks, and the control group receiving 0.1%hydrocortisone butyrate ointment. Severity of AD w as measured by SCORAD index. Results It was shown that AD mainly affected infant s and children with a prevalence of 73.24%in patients less than 12 years old. T he rates of bacterial and fungal colonization were 53.51%, 1.41%, respectively on skin lesions. S.aureus was detected in 35.21%of patients with AD. Antimicro bial susceptibility test indicated that S.aureus was sensitive to rifampin, vanc omycin, amikacin, ciprofloxacin, cefazolin, cefuroxime, etc. It was found that 1 %econazole+0.1%triamcinolone acetonide cream had significantly more advantage over hydrocortisone butyrate ointment in the therapeutical effects (P< 0.05) an d clearance of bacteria (P< 0.01). There were no side effects in the two groups. Conclusions The therapeutic effect of 1%econazole+0.1%triamcinolone acetonid e cream is better than that of hydrocortisone butyrate ointment because of the c learance of bacterial colonization of the former.