4种染液在真菌直接镜检中的效果比较

目的 评价4种染液10%KOH溶液、20%KOH溶液+40%二甲基亚砜（DMSO）混合液、乳酸酚棉蓝染液、荧光染液]在真菌镜检中阳性率之间的差异,为临床提供更高诊断效率的检测方法。方法 收集2019年9月至11月在我院皮肤科门诊就诊并进行真菌直接镜检的患者200例,将收集的标本每份均分成4份,同时用4种染液进行真菌直接镜检,对镜检结果进行统计学分析。结果 收集的200例样本中,10%KOH溶液阳性86例,占43.0%;20%KOH溶液+40%DMSO混合液阳性92例,占46.0%;乳酸酚棉蓝染液阳性79例,占39.5%;荧光染液阳性132例,占66.0%。4种染液之间的阳性率差异具有统计学意义（P<0.05）,荧光染液的使用在不同部位和不同拟诊中的真菌阳性率均高于其他3种染液。与真菌培养的结果比较,10%KOH溶液、20%KOH溶液+40%二甲基亚砜（DMSO）混合液、乳酸酚棉蓝染液、荧光染液镜检方法的敏感度分别为55.6%、60.0%、53.3%、86.7%,特异度分别为60.6%、58.1%、64.5%、40.0%,诊断符合率分别为59.5%、58.5%、62.0%、50.5%。受试者工作特征曲线（ROC曲线）中,4种染液的曲线下面积（AUC）由高至低依次为荧光染液（0.633,P<0.05）、20%KOH溶液+40%DMSO（0.590,P>0.05）、乳酸酚棉蓝染液（0.589,P>0.05）、10%KOH溶液（0.581,P>0.05）。结论 与10%KOH溶液、20%KOH溶液+40%DMSO和乳酸酚棉蓝染液相比较,荧光染液的诊断效果在真菌镜检中的阳性率更高,荧光染色在浅部真菌感染快速鉴别诊断中具有较高的临床应用价值,是一种更加快速、有效、直观的检测方法。

Comparison of the effects of four dyes in direct microscopic examination of fungi

Objective To evaluate the difference between the positive rates of four kinds of dye solution 10% potassium hydroxide (KOH) solution, 20% KOH solution + 40% dimethyl sulfoxide (DMSO) mixture, lactic acid phenol cotton blue dye solution, fluorescence dye solution] in fungal microscopy, so as to provide clinical detection methods with higher diagnostic efficiency. Methods A total of 200 cases were collected from patients who visited the dermatology outpatient clinic of our hospital and underwent direct microscopic examination of fungi from September to November 2019. The collected specimens were all divided into four parts, and at the same time, four kinds of dye liquor were used for direct microscopic examination of fungi, and the results of the microscopic examination were statistically analyzed. Results Of the 200 samples collected, 86 samples were positive by 10% KOH solution, accounting for 43.0%; The mixture of 20% KOH solution + 40% DMSO was positive in 92 cases, 46.0%; Seventy nine cases were positive for lactophenol cotton blue dye, 39.5%; Fluorescent stains were positive in 132 cases, 66.0%. The difference of positive rates among the 4 kinds of dye was statistically significant (P<0.05), and the use of fluorescent dye solution had a higher positive rate of fungi than the other 3 kinds of dye at different sites and in different proposed diagnoses. When compared with fungal cultures, the sensitivity of the four dye chromoscopy methods was 55.6%, 60.0%, 53.3%, 86.7%, and the specificity was 60.6%, 58.1%, 64.5%, 40.0%, respectively, and the diagnostic concordance was 59.5%, 58.5%, 62.0%, 50.5%, respectively. In the receiver operating characteristic (ROC) curve, the areas under the curve (AUC) of the four kinds of dye solutions, in decreasing order, were fluorescence dye solution (0.633, P<0.05), 20% KOH solution + 40% DMSO (0.590, P>0.05), lactic phenol cotton blue dye solution (0.589, P>0.05), 10% KOH solution (0.581, P>0.05). Conclusion s Compared with 10% KOH solution, 20% KOH solution + 40% DMSO and lactic acid phenol cotton blue dye solution, the diagnostic efficacy of fluorescence dye solution in fungal fungal microscopy is higher, fluorescence staining has a high clinical value in the rapid differential diagnosis of superficial fungal infection, is a more rapid and effective visual detection method.