皮肤镜和溶甲涂片镜检在甲真菌病诊断中的应用

Study on the application value of dermoscopy and nail lysate microscopy in the diagnosis of onychomycosis

目的观察并统计皮肤镜与溶甲涂片镜检两种实验诊断方法对于诊断甲真菌病的一致性,完善甲真菌病的皮肤镜下表现。方法选取2017年5月到2018年12月山西医科大学第一医院拟诊为甲真菌病120例,用双盲法分别行皮肤镜及溶甲涂片镜检检查,比较两者吻合度。结果与溶甲涂片镜检相比,皮肤镜的真菌检出率较低,差异有统计学意义(90.0%比81.7%,χ^2=25.628,P<0.05)。皮肤镜诊断的灵敏度为87.96%,特异度为75.00%,总符合率为86.67%。108例甲真菌病的皮肤镜下表现:废墟样外观95例(87.96%)、纵向条纹型93例(86.11%)、锯齿状边缘52例(48.15%)、甲下出血碎片27例(25.00%)、横向条纹型8例(7.41%)、团块状外观11例(10.19%)、甲板增厚108例(100%)、颜色改变108例(100%)、无光泽甲108例(100%)。结论皮肤镜可作为临床上甲真菌病的一项快捷有效的诊断方法,用于溶甲涂片镜检的补充。甲真菌病的特征性皮肤镜表现有废墟样外观、锯齿状边缘、纵向条纹,团块状外观、横向条纹为本次实验新发现的类型。

Objective To observe and count the the consistency of two experimental diagnostic methods of dermoscopy and nail lysate microscopy for the diagnosis of onychomycosis and to summarize the microscopic appearance of onychomycosis.Methods Continuously selected 120 patients who were diagnosed as onychomycosis in the dermatology clinic of our hospital from May 2017 to December 2018.Each patient was treated with a double-blind method for dermoscopy and the nail lysate microscopy,and check the comparison of the two.Results(1)Compared with the nail lysate microscopy,the detection rate of fungi in dermatoscopy was lower,and the difference was statistically significant(90.0%vs.81.7%,χ~2=25.628,P<0.05).The sensitivity of dermascopic diagnosis was 87.96%,the specificity was 75.00%,and the total coincidence rate was 86.67%.(2)Dermatological manifestations of 108 cases of onychomycosis:95 cases of ruin appearance(87.96%),93 cases of longitudinal stripe type(86.11%),52 cases of jagged edges(48.15%),and 27 cases of splinter hemorrhage(25.00%)),8 cases of horizontal stripe(7.41%),11 cases of lumpy appearance(10.19%),108 cases of thick nail(100%),108 cases of color change(100%),108 cases of matte nail(100%)).Conclusion Dermatoscopy can be used as a quick and effective diagnostic method for clinical diagnosis of onychomycosis,and it can be used as a supplement for nail lysate microscopy.Ruin appearance,jagged edge,longitudinal stripes were characteristic dermoscopy features of it.The horizontal striae and clumpy appearance were newly discovered types in this experiment.