皮肤镜联合墨汁染色法在疥疮诊断中的价值

The Diagnostic Value of Dermoscopy Combined with Ink Staining in Scabies

目的探讨皮肤镜结合墨汁染色法在疥疮诊断中的价值。方法选取2020年1—12月本院皮肤科门诊符合疥疮流行病学史和临床表现的患者343例。所有患者均采用3种诊断方法进行检查:刮片后显微镜镜检(刮片法)、单纯皮肤镜镜检(皮肤镜法)和皮肤镜联合墨汁染色镜检(联合法)。以刮片法阳性作为“金标准”,根据不同诊断方式绘制ROC曲线,并运用Cohen′s kappa分别比较皮肤镜法和联合法在疥疮中的诊断效能。结果ROC曲线分析结果表明,联合法的曲线下面积(AUC=0.835±0.026,95%CI:0.785~0.885)大于皮肤镜法(AUC=0.780±0.026,95%CI:0.728~0.832)。Cohen′s kappa一致性分析结果表明:皮肤镜法与金标准结果为“中等一致性”(Kappa=0.540,P=0.045,95%CI:0.207~0.764);联合法与金标准结果为“高度一致性”(Kappa=0.702,P=0.040,95%CI:0.181~0.819)。结论两种分析结果均显示皮肤镜联合墨汁染色法的诊断效果优于单纯皮肤镜镜检法。对于符合疥疮流行病学史和临床表现的患者,优先采用皮肤镜联合墨汁染色法是一种切实可行的检查方法,可以用于对疑似疥疮患者的初步筛查和诊断。

Objective To explore the diagnostic value of dermoscopy combined with ink staining in scabies.Methods A total of 343 patients consistent with scabies epidemiological history and clinical manifestations were selected from the dermatology outpatient department of our hospital from January to December 2020.All patients were examined by 3 diagnostic methods:microscopic examination after scraping(scraping method),simple dermoscopy(dermoscopy method)and dermoscopy combined with ink staining(combined method).Scraping method was considered as the gold standard.The ROC curves was drawn according to different diagnostic methods,and then used the Cohen′s kappa consistency analysis showed that the results of dermoscopy method with gold standard were‘moderate consistency’(Kappa=0.540,P=0.045,95%CI:0.207⁃0.764),and the results of combined method with gold standard were‘substantial’(Kappa=0.702,P=0.040,95%CI:0.181⁃0.819).Conclusion The results of two kinds of analysis showed that the diagnostic effect of dermoscopy combined with ink staining is better than that of simple dermoscopy.For patients in accordance with the epidemiological history and clinical manifestations of scabies,dermoscopy combined with ink staining is a feasible method,which can be used for preliminary screening and diagnosis of suspected scabies.