共聚焦激光扫描显微镜在皮肤浅部真菌感染诊断中应用价值的评估

Application of confocal laser scanning microscopy in the diagnosis of superficial cutaneous fungalinfections

目的探讨皮肤共聚焦激光扫描显微镜（CLSM）在常见浅部真菌感染诊断中的应用价值。方法根据临床病史及体征初步诊断为浅部真菌感染患者59例，选定3处典型皮损做CLSM检查，记录各项指标的扫描结果，再行真菌镜检。结果CLSM检测的25例手足癣患者中，14例（56％）角质层内可见菌丝，真菌镜检均阳性；11例角质层内未发现菌丝，真菌镜检8例阳性；新皮损（〈3周）共8例，CLSM阳性7例，真菌镜检均阳性；旧皮损（〉3周）共17例，CLSM阳性7例（41％），真菌镜检阳性14例（82％）。在检测的24例股癣患者中，19例（79．17％）角质层内可见菌丝，真菌镜检均阳性；5例角质层内未发现菌丝，真菌镜检4例阳性；新皮损（〈3周）共17例，CLSM阳性16例（94．12％），真菌镜检均阳性；旧皮损（〉3周）共7例，CLSM阳性3例，真菌镜检阳性6例。在检测的10例花斑糠疹患者中，CLSM均未发现菌丝，而真菌镜检阳性8例。外用联苯苄唑乳膏2周后的10例手足癣、股癣患者，CLSM检查均未见菌丝，角质层完整，真菌镜检阴性。结论CLSM在手足癣、股癣的新发皮损的检查上与真菌镜检具有较高的一致性，在临床诊断上有一定的应用价值。

Objective To estimate the performance of confocal laser scanning microscopy （CLSM） in the diagnosis of superficial cutaneous fungal infections. Methods This study recruited 59 patients with clinically suspected superficial cutaneous fungal infections. Three typical lesions were selected in each patient for CLSM and microscopic examination. Results CLSM revealed hyphae in stratum corueum in 56% （14/25） of tinea manus or pedis and 79.17% （19/24） of tinea cruris lesions, 7 out of 8 tinea manus or pedis and 94.12% （16/17） of tinea cruris early lesions （〈 3 weeks）, and 41% （7/17） of tinea manus or pedis and 3 out of 7 tinea cruris old lesions （〉 3 weeks）. All the CLSM-positive specimens were positive for microscopic examination, and among the CLSM-negative specimens, fungal elements were observed by microscopic examination in 8 out of 11 tinea manus or pedis specimens, 4 out of 5 tinea cruris specimens, 1 tinea manus or pedis and 1 tinea cruris specimen of early lesions, and 7 out of 10 tinea manus or pedis and 3 out of 4 tinea cruris specimens of old lesions. No hypha was found by CLSM in any of the 10 tinea versicolor specimens, while microscopic examination revealed fungal elements in 8 of them. Neither CLSM nor microscopy revealed fungal elements in lesions from 5 patients with tinea manus or pedis and 5 patients with tinea cruris after treatment with topical bifonazole cream for 2 weeks. Conclusions CLSM shows a good consistency with light microscopy in the examination of early lesions of tinea manus and pedis as well as tinea cruris, and may serve as a valuable tool for clinical diagnosis.