CFW荧光染色法在甲真菌病诊断中的应用研究

中国真菌学杂志　 2018, Vol. 13 　Issue (1): 8-10,45.

CFW荧光染色法在甲真菌病诊断中的应用研究

岳学苹¹, 石秀艳², 陈伟², 万喆², 李若瑜², 王爱平², 李清¹

1. 首都医科大学附属北京天坛医院皮肤性病科, 北京 100050;
2. 北京大学第一医院皮肤性病科北京大学真菌和真菌病研究中心, 北京 100034

收稿日期:2017-03-21 出版日期:2018-02-28 发布日期:2018-02-28
通讯作者: 李清,E-mail:bjttpfk6650@hotmail.com;王爱平,E-mail:wangap516@163.com E-mail:bjttpfk6650@hotmail.com;wangap516@163.com
作者简介:岳学苹,女(汉族),博士,副主任医师.E-mail:yuexpyue123@126.com;石秀艳,女(汉族),硕士,主治医师.E-mail:pijiu108@yeah.net
基金资助:
北京市自然科学基金（7164255）

Evaluate the accuracy of CFW fluorescent staining for the diagnosis of suspected onychomycosis

YUE Xue-ping¹, SHI Xiu-yan², CHEN Wei², WAN Zhe², LI Ruo-yu², WANG Ai-ping², LI Qing¹

1. Department of Dermatology & Venereology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China;
2. Department of Dermatology & Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, Beijing 100034, China

Received:2017-03-21 Online:2018-02-28 Published:2018-02-28

摘要/Abstract

摘要：

目的评估CFW（Calcofluor white）荧光染色法诊断甲真菌病的阳性率、准确性和效率。方法临床怀疑甲真菌病患者的病甲，同时进行10% KOH溶液湿片法镜检、真菌培养和CFW荧光染色法镜检，计算各自真菌检出阳性率，并统计CFW法与KOH镜检法或真菌培养的差异，比较KOH与CFW镜下特点。结果共入组100例拟诊为甲真菌病患者。CFW法镜检阳性率64%，KOH法镜检阳性率63%，真菌培养阳性率31%。CFW法与KOH法镜检阳性率比较差异无统计学意义（P>0.05）；CFW法镜检与真菌培养阳性率比较差异有统计学意义（P<0.01）。但CFW制片比KOH更加简单、快速，镜下显示的真菌更清晰易辨。结论 CFW荧光染色法是一种方便、快速、准确性较高的诊断方法，可以提高甲真菌病诊断的准确性和效率。

关键词: 甲真菌病, CFW荧光染色, KOH溶液湿片法, 真菌培养

Abstract:

Objective Evaluate the positive rate,accuracy and efficiency of CFW (Calcofluor white) fluorescent staining for the diagnosis of suspected onychomycosis.Methods Outpatients suspected to have onychomycosis were recruited.Each patient was subjected to three methods (CFW fluorescent staining,KOH microscopy and fungal culture) together to confirm the diagnosis.Then we compared the positive rates and the statistically significant differences across the three methods.Moreover,the images under KOH and CFW were also compared. Results One hundred patients with 100 affected nails were recruited.Among them,the positive rates of the CFW,KOH,and culture were 64%,63%,and 31%,respectively.According to the McNemar test,CFW had a higher percentage of positive rate than culture testing (P<0.01),but it was not statistically significant different from KOH (P>0.05).Compared with KOH,the preparation and examination time were faster and easier,and the fungal structures under CFW were clearer,more obvious,and more easily detected. Conclusions CFW fluorescent staining was a simple,fast,convenient,accurate,and time-efficient method.It could potentially increase the accuracy and efficiency of the diagnosis of onychomycosis and help to avoid misdiagnosis.

Key words: onychomycosis, CFW fluorescent staining, KOH microscopy, fungal culture

中图分类号:

R756.4

岳学苹, 石秀艳, 陈伟, 万喆, 李若瑜, 王爱平, 李清. CFW荧光染色法在甲真菌病诊断中的应用研究[J]. 中国真菌学杂志, 2018, 13(1): 8-10,45.

YUE Xue-ping, SHI Xiu-yan, CHEN Wei, WAN Zhe, LI Ruo-yu, WANG Ai-ping, LI Qing. Evaluate the accuracy of CFW fluorescent staining for the diagnosis of suspected onychomycosis[J]. Chinese Journal of Mycology, 2018, 13(1): 8-10,45.

参考文献

[1] Ghannoum M,Isham N.Fungal nail infections (onychomycosis):a never-ending story[J].Plos Pathogens,2014,10(6):206-211.
[2] Jung MY,Shim JH,Lee JH,et al.Comparison of diagnostic methods for onychomycosis,and proposal of a diagnostic algorithm[J].Clin Exp Dermatol,2015,40(5):479-484.
[3] Spiliopoulou A,Bartzavali C,Jelastopulu E,et al.Evaluation of a commercial PCR test for the diagnosis of dermatophyte nail infections[J].J Med Microbiol,2015,64(Pt 1):25-31.
[4] Soltani M,Khosravi AR,Shokri H,et al.A study of onychomycosis in patients attending a dermatology center in Tehran,Iran[J].2015,25(2):e81-87.
[5] Relloso S,Arechavala A,Guelfand L,et al.Onychomycosis:multicentre epidemiological,clinical and mycological study[J].Rev Iberoam Micol,2012,29(3):157-163.
[6] Haghani I,Shokohi T,Hajheidari Z,et al.Comparison of diagnostic methods in the evaluation of onychomycosis[J].Mycopathologia,2013,175(3-4):315-321.
[7] Bonifaz A,Rios-Yuil JM,Arenas R,et al.Comparison of direct microscopy,culture and calcofluor white for the diagnosis of onychomycosis[J].Rev Iberoam Micol,2013,30(2):109-111.
[8] Weinberg JM,Koestenblatt EK,Tutrone WD,et al.Comparison of diagnostic methods in the evaluation of onychomycosis[J].J Am Acad Dermatol,2003,49(2):193-197.
[9] Gupta AK,Zaman M,Singh J.Diagnosis of Trichophyton rubrum from onychomycotic nail samples using polymerase chain reaction and calcofluor white microscopy[J].J Am Podiatr Med Assoc,2008,98(3):224-228.
[10] Joseph J,Murthy S,Garg P,et al.Use of different stains for microscopic evaluation of corneal scrapings for diagnosis of microsporidial keratitis[J].J Clin Microbiol,2006,44(2):583-585.
[11] Zhang W,Yang H,Jiang L,et al.Use of potassium hydroxide,Giemsa and calcofluor white staining techniques in the microscopic evaluation of corneal scrapings for diagnosis of fungal keratitis[J].J Int Med Res,2010,38(6):1961-1967.
[12] Haldane DJ,Robart E.A comparison of calcofluor white,potassium hydroxide,and culture for the laboratory diagnosis of superficial fungal infection[J].Diagn Microbiol Infect Dis,1990,13(4):337-339.

[1]	王玲, 景东云, 王学军, 刘俊, 曹月清. 长脉宽Nd:YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效观察及对真菌超微结构的影响[J]. 中国真菌学杂志, 2020, 15(5): 268-273.
[2]	步青云, 王润超, 罗亭, 卢昌佩, 景海霞. 甲真菌病的激光治疗新进展[J]. 中国真菌学杂志, 2020, 15(5): 310-313.
[3]	徐瑾, 何咏, 黄玲珍, 胡云峰, 吴实, 刘赛君, 邓列华. 荧光染色法、双重荧光染色法与KOH湿片法在甲真菌诊断中的比较研究[J]. 中国真菌学杂志, 2020, 15(3): 167-169,172.
[4]	熊瑛, 陈婷, 柴宝, 曾飞鹏, 孙文文, 吴波. 不同激光不同能量对红色毛癣菌的体外抑制评估及部分机制的探讨[J]. 中国真菌学杂志, 2019, 14(5): 292-296.
[5]	曹艳云, 孙盈翡, 徐徉, 孔伟, 徐顺明. 长脉冲1064 nm激光联合酮康唑软膏封包病甲治疗甲真菌病的临床疗效观察[J]. 中国真菌学杂志, 2019, 14(3): 154-158.
[6]	吴先伟, 邓秀娥, 汪舰笛. 艾氟康唑治疗甲真菌病的疗效和安全性[J]. 中国真菌学杂志, 2019, 14(3): 180-182.
[7]	尚元元, 喻楠, 董灵娣, 李莎莎, 刘昱奚. 血浆(1-3)-β-D葡聚糖对院内侵袭性真菌感染诊断的临床价值[J]. 中国真菌学杂志, 2018, 13(3): 168-172.
[8]	宋娜娜, 周晓伟, 李筱芳, 刘维达. 甲真菌病外用药的治疗现状及研究进展[J]. 中国真菌学杂志, 2018, 13(3): 184-187.
[9]	王若珺, 李若瑜, 王爱平. 外用抗真菌药物治疗甲真菌病进展[J]. 中国真菌学杂志, 2018, 13(2): 114-119.
[10]	臧晓慧, 姚志远. 甲真菌病严重程度分级研究进展[J]. 中国真菌学杂志, 2017, 12(3): 168-170,179.
[11]	卢祥婷, Arun Karki, 黄欣, 赵敬军. 激光治疗甲真菌病的作用机制研究进展[J]. 中国真菌学杂志, 2017, 12(3): 171-174.
[12]	谢军, 金勤, 吴丹. 复发性外阴阴道念珠菌病45例的临床治疗[J]. 中国真菌学杂志, 2017, 12(3): 152-155.
[13]	何文婧, 高志琴, 徐红, 谭静文, 蔡晴, 杨虹, 杨连娟. 82株甲真菌病致病菌分布及药敏结果分析[J]. 中国真菌学杂志, 2016, 11(5): 289-291,295.
[14]	王涵, 陈辉. 紫色毛癣菌所致儿童甲癣1例并文献复习[J]. 中国真菌学杂志, 2016, 11(5): 292-293.
[15]	黄荷, 李锦, 刘娟, 张家安, 许阳, 吴迪, 骆丹, 周炳荣. 点阵CO₂激光联合1%卢立康唑乳膏外用封包治疗甲真菌病疗效观察[J]. 中国真菌学杂志, 2016, 11(5): 298-303,297.