CAJ | 학술논문

目的探讨皮肤共聚焦激光扫描显微镜(CLSM)在常见浅部真菌感染诊断中的应用价值.方法根据临床病史及体征初步诊断为浅部真菌感染患者59例,选定3处典型皮损做CLSM检查,记录各项指标的扫描结果,再行真菌镜检.结果 CLSM检测的25例手足癣患者中,14例(56％)角质层内可见菌丝,真菌镜检均阳性；11例角质层内未发现菌丝,真菌镜检8例阳性；新皮损(＜3周)共8例,CLSM阳性 7例,真菌镜检均阳性；旧皮损(＞3周)共17例,CLSM阳性7例(41％),真菌镜检阳性14例(82％).在检测的24例股癣患者中,19例(79.17％)角质层内可见菌丝,真菌镜检均阳性；5例角质层内未发现菌丝,真菌镜检4例阳性；新皮损(＜3周)共17例,CLSM阳性16例(94.12％),真菌镜检均阳性；旧皮损(＞3周)共7例,CLSM阳性3例,真菌镜检阳性6例.在检测的10例花斑糠疹患者中,CLSM均未发现菌丝,而真菌镜检阳性8例.外用联苯苄唑乳膏2周后的10例手足癣、股癣患者,CLSM检查均未见菌丝,角质层完整,真菌镜检阴性.结论 CLSM在手足癣、股癣的新发皮损的检查上与真菌镜检具有较高的一致性,在临床诊断上有一定的应用价值.
목적 탐토피부공취초격광소묘현미경(CLSM)재상견천부진균감염진단중적응용개치.방법 근거림상병사급체정초보진단위천부진균감염환자59례,선정3처전형피손주CLSM검사,기록각항지표적소묘결과,재행진균경검.결과 CLSM검측적25례수족선환자중,14례(56％)각질층내가견균사,진균경검균양성；11례각질층내미발현균사,진균경검8례양성；신피손(＜3주)공8례,CLSM양성 7례,진균경검균양성；구피손(＞3주)공17례,CLSM양성7례(41％),진균경검양성14례(82％).재검측적24례고선환자중,19례(79.17％)각질층내가견균사,진균경검균양성；5례각질층내미발현균사,진균경검4례양성；신피손(＜3주)공17례,CLSM양성16례(94.12％),진균경검균양성；구피손(＞3주)공7례,CLSM양성3례,진균경검양성6례.재검측적10례화반강진환자중,CLSM균미발현균사,이진균경검양성8례.외용련분변서유고2주후적10례수족선、고선환자,CLSM검사균미견균사,각질층완정,진균경검음성.결론 CLSM재수족선、고선적신발피손적검사상여진균경검구유교고적일치성,재림상진단상유일정적응용개치.
Objective To estimate the performance of confocal laser scanning microscopy (CLSM) in the diagnosis of superficial cutaneous fungal infections. Methods This study recruited 59 patients with clinically suspected superficial cutaneous fungal infections.Three typical lesions were selected in each patient for CLSM and microscopic examination.Results CLSM revealed hyphae in stratum corneum in 56％ (14/25) of tinea manus or pedis and 79.17％ (19/24) of tinea cruris lesions,7 out of 8 tinea manus or pedis and 94.12％( 16/17 ) of tinea cruris early lesions (＜ 3 weeks ),and 41％ (7/17) of tinea manus or pedis and 3 out of 7 tinea croris old lesions (＞ 3 weeks).All the CLSM-positive specimens were positive for microscopic examination,and among the CLSM-negative specimens,fungal elements were observed by microscopic examination in 8 out of 11 tinea manus or pedis specimens,4 out of 5 tinea cruris specimens,1 tinea manus or pedis and 1 tinea cruris specimen of early lesions,and 7 out of 10 tinea manus or pedis and 3 out of 4 tinea cruris specimens of old lesions.No hypha was found by CLSM in any of the 10 tinea versicolor specimens,while microscopic examination revealed fungal elements in 8 of them.Neither CLSM nor microscopy revealed fungal elements in lesions from 5 patients with tinea manus or pedis and 5 patients with tinea cruris after treatment with topical bifonazole cream for 2 weeks.Conclusions CLSM shows a good consistency with light microscopy in the examination of early lesions of tinea marnus and pedis as well as tinea croris,and may serve as a valuable tool for clinical diagnosis.