反射式共聚焦显微镜对足部浅表真菌感染诊断的初步研究

Preliminary study on diagnosis of reflectance confocal microscopy for superficial fungal foot infection

目的初步研究探讨反射式共聚焦显微镜(RCM)对足部浅表真菌感染的诊断价值。方法收集足部浅表真菌感染患者组和疑似足部浅表真菌感染对照组的患者进行RCM检查,计算RCM病原学检查对诊断足部浅表真菌感染的灵敏度、特异度、阳性预测值及阴性预测值。同时分析RCM非病原学显像特征对于足部浅表真菌感染鉴别诊断的价值,以及分析比较RCM在不同部位的病原学检查结果的差异。结果RCM病原学检查诊断足部浅表真菌感染的灵敏度、特异度、阳性预测值及阴性预测值分别为55.3%、92.9%、93.3%及53.4%。RCM非病原学影像表现的特征在患者组与对照组之间的差异均无统计学意义(P>0.05)。RCM共检查了患者组228个病变部位,其中表现为角化过度部位的阳性率为17.5%,表现为丘疹/水疱部位的阳性率为36.8%,差异具有统计学意义(P=0.001)。RCM在足跖、足侧缘和足跟阳性率的差异无统计学意义(P>0.05)。结论RCM除了具有病原学检查的基本特征,还具有检测病变部位组织病理学改变及实时、多部位检查等优势,可以作为诊断足部浅表真菌感染的补充辅助检查工具。

ObjectiveTo preliminarily evaluate the diagnostic value of reflectance confocal microscopy(RCM)for superficial fungal infection of the foot.Methods Cases for superficial fungal infection of the foot andclinically suspicious ones were collected to perform RCM,to calculate and compare the diagnostic sensitivity,specificity,positive predictive value,and negative predictive value of RCM to detect fungal hyphae.Meanwhile,the positive results of RCM on different lesions and parts of the feet were measured and compared.ResultsThe sensitivity,specificity,positive predictive value,and negative predictive value of RCM to diagnose superficial fungal infection of the foot were 55.3%,92.9%,93.3%and 53.4% respectively.The differences in main features except for hyphae under RCM between the case group and control group were not significant(P>0.050).228 multi-positions were examined by RCM in the case group,the positive rate of the sites that manifested hyperkeratosis is 17.5%,and 36.8%for sites with papules/blisters,the difference between the positive rate of the two was statistically significant(P=0.001).However,there was no significant difference in the positive rates for RCM to observe the hyphae on the foot plantar,margin,and heel(P>0.050).Conclusion RCM can be recommended as an early and complementary examination tool to diagnose superficial fungal foot infection,because of its advantages of real-time,multi-site examination and detection of histological features of lesions,besides the fundamental feature to detect fungal hyphae.