异硫氰酸荧光染色法在真菌性角膜炎诊断中的应用观察

Clinical application of fluorescein isothiocyanate staining in the diagnosis of fungal keratitis

目的比较异硫氰酸荧光素(FITC)荧光染色法与KOH涂片法联合革兰染色法在真菌性角膜炎患者中真菌的检出率。方法收集2019年1~5月在十堰市太和医院眼科诊断为角膜炎并同时进行角膜刮片行KOH涂片、革兰染色及行FITC荧光染色检查的42例(42只眼)患者的资料。结果FITC荧光染色法观察到染成亮绿色的真菌菌丝或孢子,周围有少许蓝色光晕;其中菌丝表现为单根至大量不等的竹节样结构,而孢子表现为圆形、椭圆形结构。细菌则不能显示。42例患者中诊断为真菌性角膜炎14例,其中病原学诊断13例、临床诊断1例。FITC荧光染色法在真菌性角膜炎中真菌的检出率为85.7%,高于KOH涂片法联合革兰染色法的50%,P<0.05,差异有统计学意义。结论FITC荧光染色法具有快速、高效的真菌检出率,且操作简单,非常值得临床推广使用,建议将FITC荧光染色法作为可疑真菌性角膜炎的首选辅助检查方法。

Objective To compare the detection rate of fungus in patients with fungal keratitis by fluorescein isothiocyanate(FITC)staining and KOH smear combined with Gram staining.Methods Data of 42 patients with keratitis diagnosed in the Taihe Hospital of Shiyan city,who underwent KOH smear,Gram staining and FITC staining from January 2019 to May 2019 were collected.Results FITC staining showed stained bright green fungal hyphae or spores with a surrounding blue glow.Fungal hyphae appeared as single or multiple bamboo-like structures,while spores appeared as round or oval structures.Bacteria cannot be displayed by FITC staining.Among these patients,14 were diagnosed as fungal keratitis,including 13 cases of pathogenic diagnosis and 1 case of clinical diagnosis.The positive detection rate of fungus by FITC staining was 85.7%,which was higher than that of KOH smear combined with Gram staining(50%),and the difference was statistically significant(P<0.05).Conclusions FITC staining method is rapid and has high efficiency in detection of fungus,is easy to operate,and thus worthy of clinical application.We recommend it as the first choice for auxiliary examination for patients with suspected fungal keratitis.