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影响甲真菌病白色念珠菌治疗效果的预后因素。

Prognostic factors influencing the treatment outcome of onychomycosis Candida.

机构信息

Department of Dermatology and Venereology, Faculty of Medicine, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.

Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

出版信息

Mycoses. 2020 Jan;63(1):71-77. doi: 10.1111/myc.13018. Epub 2019 Nov 5.

DOI:10.1111/myc.13018
PMID:31603597
Abstract

Onychomycosis contributes as many as half of all nail disorder cases. In 2017, the incidence of onychomycosis was 15% of all dermatomycosis cases at our hospital, a tertiary hospital in Indonesia, with only 25% of the patients achieving mycological cure. This study aims to identify the prognostic factors influencing the treatment outcome of onychomycosis Candida. This is a retrospective study, using data obtained from outpatient registry at our hospital. Fifty-four onychomycosis patients were included in this study. Potential prognostic factors were analysed by STATA15.0. Retrospective analysis with cox proportional-hazard was used to measure the contribution of each variable to the treatment's outcome. Onset of disease, history of nail disorder, and site of infection were not associated with mycological cure (P > .05). Based on retrospective analysis, age[odds ratio (OR)1.46; 95% confidence interval (CI)1.07-2.03], onset of disease (OR 1.14; 95%CI 1.11-1.17), comorbidities (OR 1.07; 95%CI 1.03-1.11), type of onychomycosis (OR 1.08; 95%CI 1.05-1.16), site of infection (OR 1.12; 95%CI 1.04-1.22) and number of infected nails (OR 1.50; 95%CI 1.25-1.68) were significantly associated with poor treatment outcome, while type of treatment and type of systemic agents showed no significant association with the outcome. Kaplan-Meier curves showed that subjects elderly age and more than 3 infected nails had the lowest median survival. Elderly, longer onset, presence of comorbidities, multiple sites of infection, and high number of infected nails can affect the mycological cure negatively. Unstandardised treatment was associated with the mycological cure despite not affecting the prognosis. Therefore, the management's goal is to identify these specific prognostic features.

摘要

甲真菌病导致的指甲疾病占所有指甲疾病的一半以上。2017 年,我院(印度尼西亚一家三级医院)皮肤科甲真菌病患者中有 15%为甲真菌病,仅有 25%的患者达到真菌学治愈。本研究旨在确定影响甲真菌病 Candida 治疗结果的预后因素。这是一项回顾性研究,使用我院门诊登记处获得的数据。本研究纳入了 54 例甲真菌病患者。采用 STATA15.0 分析潜在的预后因素。采用 COX 比例风险回顾性分析来衡量每个变量对治疗结果的贡献。发病时间、指甲疾病史和感染部位与真菌学治愈无关(P>.05)。基于回顾性分析,年龄[比值比(OR)1.46;95%置信区间(CI)1.07-2.03]、发病时间(OR 1.14;95%CI 1.11-1.17)、合并症(OR 1.07;95%CI 1.03-1.11)、甲真菌病类型(OR 1.08;95%CI 1.05-1.16)、感染部位(OR 1.12;95%CI 1.04-1.22)和感染指甲数(OR 1.50;95%CI 1.25-1.68)与较差的治疗结果显著相关,而治疗类型和系统药物类型与结果无显著相关性。Kaplan-Meier 曲线显示,年龄较大和感染指甲数超过 3 个的患者中位生存期最低。年龄较大、发病时间较长、合并症、多个感染部位和感染指甲数较多可能会对真菌学治愈产生负面影响。未标准化治疗与真菌学治愈相关,尽管它不影响预后。因此,管理的目标是识别这些特定的预后特征。

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