Wilhelm L, Wilhelm E, Thomas H, Bernhardt H
Klinik für Chirurgie, Greifswald.
Langenbecks Arch Chir. 1996;381(2):88-94. doi: 10.1007/BF00183938.
Fungus infections are becoming more important in surgical intensive medicine, and various preparations are now available to treat them. The goal of our investigations was to determine the influence of the antimycotics in current use on the microbicide phagocytic function by measuring chemiluminescence. To this end the luminol-enhanced chemiluminescence in whole blood samples from a total of 29 healthy donors was measured with a LKB 1251 Luminometer after stimulation with zymosan or a Canadida albicans preparation. We tested the substances amphotericin B, flucytosin (Ancotil), fluconazol (Diflucan) and itraconazol (Sempera), each in three different concentrations within the recommended dose range and compared the results with those in an untreated sample. For the insertions of amphotericin B or intraconazol after zymosan stimulation no significant differences in the measurements were found (50.84 vs 47.99 mV and 46.10 vs 47.89 mV) compared with the blank test. Similar situations revealed by the tests with C. albicans administration (15.21 vs 12.35 mV and 11.16 vs 11.91 mV). However, the tests with flucytosin in the higher concentration range, after stimulation with either zymosan or C. albicans, evidenced a significant reduction in the measurements (34.70 vs 52.74 mV, P<0.005, and 10.98 vs 14.57 mV, P<0.01). The tests with fluconazol showed a decrease of the chemiluminescence exclusively for the highest concentration in the C. albicans group (14.36 vs 17.20 mV, P<0.005). Our results indicate a negative influence of the phagocytes on the oxidative metabolism especially with flucytosin in the higher concentrations. This emphatically confirms demands for exact indications and dosage of antimycotics and their correct administration.
真菌感染在外科重症医学中日益重要，目前有多种制剂可用于治疗此类感染。我们研究的目的是通过测量化学发光来确定当前使用的抗真菌药物对杀菌剂吞噬功能的影响。为此，我们用LKB 1251型发光计测量了总共29名健康供体全血样本中鲁米诺增强的化学发光，这些样本在用酵母聚糖或白色念珠菌制剂刺激后进行测量。我们测试了两性霉素B、氟胞嘧啶（安可替）、氟康唑（大扶康）和伊曲康唑（斯皮仁诺）这几种物质，每种物质在推荐剂量范围内均采用三种不同浓度进行测试，并将结果与未处理样本的结果进行比较。在酵母聚糖刺激后注射两性霉素B或伊曲康唑，与空白试验相比，测量结果无显著差异（分别为50.84对47.99 mV和46.10对47.89 mV）。白色念珠菌给药试验也显示了类似情况（分别为15.21对12.35 mV和11.16对11.91 mV）。然而，在较高浓度范围内，用酵母聚糖或白色念珠菌刺激后进行氟胞嘧啶测试，测量结果明显降低（分别为34.70对52.74 mV，P<0.005；以及10.98对14.57 mV，P<0.01）。氟康唑测试表明，仅在白色念珠菌组的最高浓度下化学发光有所降低（14.36对17.20 mV，P<0.005）。我们的结果表明，吞噬细胞对氧化代谢有负面影响，尤其是高浓度的氟胞嘧啶。这有力地证实了对抗真菌药物准确适应症、剂量及其正确给药的要求。
