相差显微镜检查皮肤真菌的应用价值

Direct Examination of the Application Value of Skin Fungi by Phase Contrast Microscopy

目的探讨相差显微镜直接检查皮肤真菌结构的方法及临床意义。方法选取2016年8月—2017年3月天津市北辰区中医医院门诊疑似真菌感染患者82例,轻刮取患者疑似真菌感染的毛发、指(趾)甲或皮屑于滴有1滴10%KOH的载玻片上。分别置于光学高倍镜、相差高倍镜或相差油镜下观察真菌孢子和菌丝。比较两种显微镜相同的放大倍数,而观察镜下物体易辨性不同。以评价相差显微镜在直接检查皮肤真菌的可行性,建立操作规程、筛查内容、报告方式。结果相差显微镜检测真菌孢子样物体阳性率为61.0%(50/82),检测真菌菌丝阳性率为14.6%(12/82);光学显微镜检测真菌孢子样物体阳性率为53.7%(44/82),检测真菌菌丝阳性率为4.9%(4/82)。相差显微镜和光学显微镜检测真菌孢子样物体阳性率比较,差异无统计学意义(χ~2=0.90,P>0.05);相差显微镜和光学显微镜检测真菌菌丝阳性率比较,差异有统计学意义(χ~2=4.17,P<0.05)。结论相差高倍镜观察上皮细胞内真菌的轮廓更清晰,视觉立体效果更佳,尤其易于排除附着在上皮细胞上的杂质,特别是疑似真菌菌丝和孢子时可用相差油镜来鉴别。因此,相差镜直接检查皮肤真菌是一种经济、简便快捷的常规初筛方法,符合作为真菌快速诊断的要求。

Objective Explore the method and clinical significance of direct microscopic examination of fungal pathogen morphology by phase contrast microscope.Methods Lightly infected hair,fingers(toenails),or dander of a suspected fungal infection on a drop of 10%KOH slide,fungal spores and hyphae were observed at high magnification under different lenses or with different lenses.The same magnification of the two microscopes was observed,while the object under observation is different in clarity.In order to evaluate the feasibility of phase contrast microscope in direct examination of skin fungi,establish operating procedures,screening content and reporting methods.Results The Phase contrast microscope positive rate of fungal spores was 61.0%(50/82).The Fungal hyphae positive detection rate of 14.6%(12/82).The Optical microscope fungal spores positive detection rate of 53.7%(44/82).The Fungal hyphae positive detection rate of 4.9%(4/82)(P<0.05),positive rate significantly lower than the former.Conclusion Higher magnification of epithelial cells of the fungi in the outline,better stereoscopic effect,especially easy to eliminate impurities in epithelial cells,especially suspected fungal hyphae and spores are available when the difference of oil identification.Therefore,phase contrast microscopy is an economical,simple and rapid method for routine screening of skin fungi,which meets the requirements of rapid diagnosis of fungi.