浅部真菌病荧光染色显微成像及计算机辅助诊断系统的初步临床应用

Preliminary clinical application of fluorescence microscopic imaging and computer-aided diagnosis system in the diagnosis of superficial cutaneous fungal infections

目的评估荧光染色显微成像及计算机辅助诊断系统(AFMICADS)在临床上辅助诊断浅部真菌感染的准确性。方法2018年7-9月选择华中科技大学同济医学院附属协和医院各临床科室门诊及住院疑似浅部真菌感染患者106例,送检标本126份,其中皮肤鳞屑83份,甲屑43份,分别进行常规镜检、改良沙氏培养基培养及荧光染色镜检(人工荧光镜检和AFMICADS荧光镜检)。以常规镜检和/或真菌培养阳性(仅满足任意1项即可为阳性)为标准,计算3种镜检方法的准确率、敏感性和特异性。统计分析采用SPSS10.0软件,McNemar检验和Kappa检验分析3种镜检方法与常规镜检和/或真菌培养结果的差异及一致性,诊断符合率检验分析3种镜检方法两两之间一致性的差异。结果126份标本中,人工荧光镜检阳性124份(98.4%),AFMICADS荧光镜检阳性123份(97.6%),阳性率均高于常规镜检和/或真菌培养法[阳性98份(77.8%),均P<0.001]。AFMICADS荧光镜检的敏感性为100%,特异性为10.7%,一致性为80.2%;人工荧光镜检的敏感性100%,特异性7.1%,一致性79.4%,两种方法的一致性差异无统计学意义(P>0.05)。结论AFMICADS荧光镜检浅部真菌感染标本的一致性与人工荧光镜检相当。

Objective To evaluate the accuracy of automated fluorescence microscopic imaging and computer-aided diagnosis system (AFMICADS) in the auxiliary diagnosis of superficial cutaneous fungal infections. Methods Totally, 106 outpatients and inpatients with suspected superficial fungal infections were enrolled from clinical departments of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between July 2018 and September 2018. A total of 126 specimens were collected, including 83 skin scales and 43 nail parings. Each specimen was divided into 3 groups to be examined by conventional fungal microscopy, culture with modified Sabouraud dextrose agar and fluorescence microscopy (artificial fluorescence microscopy and AFMICADS-based fluorescence microscopy) respectively. A positive result was defined as that conventional fungal microscopy and/or fungal culture was positive. Consistency rate, sensitivity and specificity of the 3 microscopic methods were calculated. Statistical analysis was carried out with SPSS 10.0 software by using McNemar test and Kappa test for analyzing difference in the positive rate, as well as consistency, between the 3 microscopic methods and the positive standard, and by using efficiency test for comparing the consistency rate among the 3 microscopic methods. Results Of 126 specimens, 124 (98.4%) were positive for artificial fluorescence microscopy, and 123 (97.6%) for AFMICADS-based fluorescence microscopy. Both positive rates of the above 2 microscopic methods were significantly higher than the positive rate of the positive standard (77.8%, both P < 0.001). The sensitivity, specificity and consistency rate of AFMICADS-based fluorescence microscopy were 100%, 10.7% and 80.2% respectively, and those of artificial fluorescence microscopy were 100%, 7.1% and 79.4% respectively. Additionally, no significant difference in the consistency was observed between the AFMICADS-based and artificial fluorescence microscopy(P > 0.05). Conclusion The accuracy of AFMICADS-based fluorescence microscopy in the diagnosis of superficial cutaneous fungal infections is similar to that of artificial fluorescence microscopy.