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念珠菌为条件致病真菌,可寄居于人体的不同部位,当人体局部或全身免疫力下降时,其致病性可造成个体浅表或全身感染。白念珠菌(Candidaalbicans)是念珠菌的一种,是引发侵袭性感染的最主要致病菌[1]。近年来,由于抗真菌药物的大量使用,白念珠菌的耐药性逐渐增加。常规抗菌药对白念珠菌的抑制效果明显降低。
相对于单药而言,多种药物联合使用时往往能通过药效互补,起到协同作用,增强抑菌效果[2-3]。联合用药提高了抑菌效果,患者的治疗周期缩短,治疗成本可进一步降低。因此,研究抗白念珠菌药物联合疗法对于治疗白念珠菌感染非常有意义。
一般来说,联合疗法会同时使用抗真菌药和增效剂。目前经典的抗真菌药物有唑类化合物(如氟康唑)、多烯类(如两性霉素B)和棘白菌素类(如卡泊芬净)等,这些药物可直接抑制或杀伤白念珠菌。氯法齐明、法尼醇本身对真菌没有直接抑制作用,但可作为增效剂辅助增强抗真菌药物治疗效果,增强耐药菌的敏感性。近年来,光动力学、声动力学疗法等新兴的技术应用于抗真菌的治疗,同时传统的抗真菌物质在现代技术的改进下也能发挥特有的优势,比如将银制成纳米银颗粒用于抑制白念珠菌增殖。本文将针对白念珠菌尤其是耐药菌的杀伤或抑制作用,聚焦于传统抗真菌药物与声动力学/光动力学疗法、纳米银颗粒这几类抗菌方式,阐述与之相关的联合疗法。
Research progress on drug combination therapy against Candida albicans
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摘要: 白念珠菌是念珠菌属最常见的种类之一,是临床上重要的侵袭性念珠菌感染来源。由于传统抗真菌药物的广泛使用,临床已经分离出很多耐药白念珠菌,导致部分传统药物在临床治疗效果明显下降。同时,一些化合物自身的毒性限制了其临床应用。在这种背景下,联合疗法由于发挥了各种药物或手段的协同作用,有可能改进单独用药的不足,具有抑制白念珠菌生长的巨大潜力。Abstract: Candida albicans is one of the most common species of Candida, which is an important cause of invasive candidiasis in clinic. Due to the frequently use of classical antifungal agents, there are amounts of drug resistant C. albicans being isolated, causing the significantly decreasing of the efficacy of some antifungal agents in clinical treatment. Besides, the use of some compounds in clinic has been limited because of their toxicities. In such a context, drug combination therapy shows great potential on antifungal because of the synergy of different drugs or therapeutic methods that could bring, which could improve the weaknesses of single drug.
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Key words:
- Candida albicans /
- combination therapy /
- azole /
- polyenes /
- echinocandins /
- photodynamic therapy /
- ultrasonic therapy /
- silver nanoparticles
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