荧光染色法在面部皮肤蠕形螨检查中的应用评估

Application of fluorescence staining in the detection of Demodex mites in the facial skin

目的探索荧光染色法在蠕形螨检查中的可行性。方法本研究为单中心半脸对照研究。招募2020年10月至2021年11月南方科技大学医院皮肤科拟诊为玫瑰痤疮、脂溢性皮炎的患者,挤粘结合法(挤粘法)取材后分别采用荧光染色和直接镜检法检查蠕形螨,比较两种方法的检出率、检出数目及平均阅片时间等,并比较荧光染色法和标准化皮肤表层取材法(SSSB)蠕形螨检出率和检出数。计数资料的比较采用卡方检验,计量资料比较采用配对t检验。结果共招募433例志愿者,年龄(28.3±3.5)岁,男185例,女248例;其中,338例对比挤粘法取材后荧光染色法和直接镜检的检出效率,95例比较挤粘法取材后荧光染色法和SSSB的检出效率。荧光染色法蠕形螨检出率[34.0%(115/338)]高于直接镜检[31.4%(106/338)],McNemar检验,P=0.004;118份阳性标本蠕形螨检出数荧光染色法[(8.0±3.3)条/cm^(2)]高于直接镜检[(5.5±2.9)条/cm^(2)],t=9.210,P<0.001;荧光染色法阅片时间[(8.3±1.2)min]短于直接镜检法[(17.3±2.5)min],t=38.44,P<0.001;荧光染色法在不同观察者之间一致性好(Kappa=0.935,P<0.001)。蠕形螨阳性率荧光染色法[34.7%(33/95)]略高于SSSB[33.7%(32/95)],McNemar检验,P<0.001;阳性标本中蠕形螨数荧光染色法[(11.4±4.2)条/cm^(2)]优于SSSB[(9.8±4.8)条/cm^(2)],t=4.77,P<0.001。结论荧光染色法蠕形螨检出率及检出数量均高于直接镜检和SSSB,不同观察者之间有更好的一致性,同时可缩短阅片时间。

Objective To analyze the feasibility of fluorescence staining in the detection of Demodex mites.Methods A single-center split-face study was conducted,and patients with clinically diagnosed rosacea or seborrheic dermatitis were enrolled from the Department of Dermatology,Southern University of Science and Technology Hospital from October 2020 to June 2021.Samples were obtained from the patients′cheeks by using the squeeze-adhesion method,and Demodex mites were detected by fluorescence staining and direct microscopic examination separately.The detection rate,number of detected Demodex mites,and time for reading slides were compared between the above two detection methods,and the detection rate and number of detected Demodex mites were further compared between the fluorescence staining and standardized skin surface biopsy(SSSB).Chi-square test was used to compare enumeration data,and paired t-test was used for measurement data.Results A total of 433 volunteers aged 28.3±3.5 years were enrolled,including 185 males and 248 females.The performance of fluorescence staining was compared with direct microscopic examination in 338 pairs of samples obtained by the squeeze-adhesion method,and compared with SSSB in 95 pairs of samples obtained by the squeeze-adhesion method.The detection rate of Demodex mites by fluorescence staining was significantly higher(34.0%,115/338)than that by direct microscopic examination(31.4%,106/338;McNemar test,P=0.004);among 118 positive samples,the number of detected Demodex mites by fluorescence staining was also significantly higher([8.0±3.3]/cm^(2))than that by direct microscopic examination([5.5±2.9]/cm^(2);t=9.21,P<0.001);the time for reading slides treated by fluorescence staining was significantly shorter(8.3±1.2 minutes)than that by direct microscopic examination(17.3±2.5 minutes;t=38.44,P<0.001);there was favorable consistency in fluorescence staining results between two clinical laboratorians(kappa=0.935,P<0.001).The detection rate of Demodex mites by fluorescence staining(34.7%,33/95)was higher than that by SSSB(33.7%,32/95;McNemar test,P<0.001);among 35 positive samples,the number of detected Demodex mites by fluorescence staining was also significantly higher([11.4±4.2]/cm^(2))than that by SSSB([9.8±4.8]/cm^(2);t=4.77,P<0.001).Conclusion Compared with direct microscopic examination and SSSB,fluorescence staining was more sensitive in the detection of Demodex mites,with better consistency between different observers and shorter time for reading slides.