中国麻风皮肤病杂志 ›› 2023, Vol. 39 ›› Issue (11): 818-821.doi: 10.12144/zgmfskin202311818

• 临床研究 • 上一篇    下一篇

皮肤镜和荧光染色在甲真菌病诊断中的应用效果分析

刘雪,王敬茶,尹鸿英,周娜娜,邱思思,景伟芳   

  1. 河北中石油中心医院皮肤科，河北廊坊，065000
  • 出版日期:2023-11-15 发布日期:2023-10-27

Application of dermoscopy and fluorescent staining in the diagnosis of onychomycosis

LIU Xue, WANG Jingcha, YIN Hongying, ZHOU Nana, QIU Sisi, JING Weifang   

  1. Department of Dermatology, Hebei Central Oil Center Hospital, Langfang 065000, China
  • Online:2023-11-15 Published:2023-10-27

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摘要： 目的：探讨皮肤镜、荧光染色在甲真菌病诊断中的应用效果。方法：收集2021年1月至2022年12月我院收治的疑诊甲真菌病患者。收集甲屑，均行氢氧化钾（KOH）直接镜检、皮肤镜检查和荧光染色。统计皮肤镜、荧光染色与KOH直接镜检结果，对甲真菌病患者临床亚型和皮肤镜特征进行分析，并采用受试者工作特征曲线（ROC）分析皮肤镜、荧光染色对甲真菌病的诊断价值。结果：共收集98例疑诊甲真菌病患者，经皮肤镜检查诊断为甲真菌病的共有86例（87.76%），经荧光染色诊断为甲真菌病的共有84例（85.71%）。KOH直接镜检阳性的87例甲真菌病患者共165个病甲，其中检出亚型包括远端侧位甲下型85个（51.52%），全甲毁损型38个（23.03%），白色浅表型42个（25.45%）。皮肤镜特征分析结果显示，锥形甲角化25个，全部为全甲损毁型；纵行条纹41个，其中全甲毁损型最多，（21个，51.22%）；锯齿状边缘106个，其中远端侧位甲下型最多（74个，69.82%）。皮肤镜和荧光染色诊断甲真菌病的曲线下面积（AUC）、敏感度、特异度、阳性预测值、阴性预测值、准确度分别为94.25%和90.80%、63.64%和54.55%、95.35%和94.05%、58.33%和42.86%、90.82%和86.73%，二者比较，差异均无统计学意义（均P>0.05）。结论：皮肤镜和荧光染色均可作为甲真菌病的临床辅助诊断方法。甲真菌病患者的皮肤镜特征主要表现为锥形甲角化、纵行条纹和锯齿状边缘。

关键词: 甲真菌病, 皮肤镜, 荧光染色

Abstract: Objective: To investigate the application of dermoscopy and fluorescent staining in the diagnosis of onychomycosis. Methods: The patients with suspected onychomycosis from January 2021 to December 2022 in Hebei central hospital of petro China were selected as the study subjects. Nail clippings were collected and examined by direct potassium hydroxide (KOH) microscopy, dermoscopy, and fluorescent staining. The results of dermatoscopy, fluorescent staining and KOH direct microscopy were statistically analyzed. The clinical subtypes and dermatoscopy characteristics of onychomycosis patients were analyzed. The diagnostic value of dermatoscopy and fluorescent staining for onychomycosis was analyzed by receiver operating characteristic curve (ROC). Results: Among 98 patients with suspected onychomycosis, 86 cases (87.76%) were diagnosed as onychomycosis according to dermoscopy images, and 84 cases (85.71%) were diagnosed as onychomycosis according to fluorescence staining. One hundred and sixty five nails in 87 cases were positive for KOH direct microscopic examination, including 85 (51.52%) of distal lateral subungual type, 38 (23.03%) of total nail damage type and 42 (25.45%) of white superficial type. Dermoscopic images showed that cone-shaped nail keratosis in 25 nails which were all the total nail damage type, longitudinal striated in 41 nails, of which 21 (51.22%) were longitudinal striated, distal lateral serrated margin in 106 nails, of which 74 were distal lateral subungual type (69.82%). The AUC value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of dermoscope and fluorescence staining in the diagnosis of onychomycosis were 94.25% and 90.80%, 63.64% and 54.55% , 95.35% and 94.05%, 58.33% and 42.86%, 90.82% and 86.73%, respectively, with no significant differences of those between dermoscopy and fluorescence staining (Ps>0.05). Conclusions: Dermoscope and fluorescent staining can be used as auxiliary clinical diagnostic methods for onychomycosis, and the main characteristics of dermoscopy in patients with onychomycosis are conical nail keratosis, longitudinal stripe nail destruction and serrated edge distal lateral subungual type.

Key words: onychomycosis, dermatoscope, fluorescence staining