CAJ | 학술논문

背景在真菌性角膜炎的临床诊治工作中,早期、快速诊断能够为患者争取治疗时间,降低致盲率.真菌培养法虽是真菌性角膜炎诊断的金标准,但由于培养周期较长,假阴性率较高,难以实现早期确诊和正确治疗. 目的研究角膜刮片镜检法与激光扫描共焦显微镜诊断真菌性角膜炎的符合率,探讨两种检查方法联合应用在临床快速诊断中的应用价值. 方法分别采用角膜刮片镜检法及激光扫描共焦显微镜对临床确诊的真菌性角膜炎患者167例167眼进行检查,所有患者均在裂隙灯显微镜下观察后行激光扫描共焦显微镜检查,观察图像特点,然后在角膜病灶处刮取标本,质量分数10％ KOH涂片后于光学显微镜下查找真菌菌丝或孢子. 结果角膜刮片镜检可查见菌丝或孢子者125例,阳性率为75％ (125/167),激光扫描共焦显微镜检查发现菌丝者152例,阳性率为91％ (152/167),激光扫描共焦显微镜检查法的阳性率明显高于刮片镜检法,差异有统计学意义(x2=14.88,P=0.00).两种检查方法结果均为阳性者114例,均为阴性者4例,两种检查的符合率为70.7％ (118/167).刮片镜检法结果阴性的42例中,38例患者行激光扫描共焦显微镜检查后可发现菌丝,激光扫描共焦显微镜检查结果阴性的15例中,刮片镜检结果阳性者11例.结论刮片镜检法和激光扫描共焦显微镜检查方法的联合应用能够提高真菌性角膜炎的快速诊断水平,降低漏诊率.
배경 재진균성각막염적림상진치공작중,조기、쾌속진단능구위환자쟁취치료시간,강저치맹솔.진균배양법수시진균성각막염진단적금표준,단유우배양주기교장,가음성솔교고,난이실현조기학진화정학치료. 목적 연구각막괄편경검법여격광소묘공초현미경진단진균성각막염적부합솔,탐토량충검사방법연합응용재림상쾌속진단중적응용개치. 방법 분별채용각막괄편경검법급격광소묘공초현미경대림상학진적진균성각막염환자167례167안진행검사,소유환자균재렬극등현미경하관찰후행격광소묘공초현미경검사,관찰도상특점,연후재각막병조처괄취표본,질량분수10％ KOH도편후우광학현미경하사조진균균사혹포자. 결과 각막괄편경검가사견균사혹포자자125례,양성솔위75％ (125/167),격광소묘공초현미경검사발현균사자152례,양성솔위91％ (152/167),격광소묘공초현미경검사법적양성솔명현고우괄편경검법,차이유통계학의의(x2=14.88,P=0.00).량충검사방법결과균위양성자114례,균위음성자4례,량충검사적부합솔위70.7％ (118/167).괄편경검법결과음성적42례중,38례환자행격광소묘공초현미경검사후가발현균사,격광소묘공초현미경검사결과음성적15례중,괄편경검결과양성자11례.결론 괄편경검법화격광소묘공초현미경검사방법적연합응용능구제고진균성각막염적쾌속진단수평,강저루진솔.
Background The rapid diagnosis can win more treating opportunities for patients with fungal keratitis.Even though the fungal culture is the gold standard for the diagnosis of fungal keratitis,it is difficult in early diagnosis due to the long duration of cultivation and false-negative rate.Objective This trial was to explore the clinical value in the rapid diagnosis of fungal keratitis by the combination of corneal scraping with laser scanning confocal microscopy.Methods Corneal scraping and laser scanning confocal microscopy were separately performed in 167 eyes of 167 patients with fungal keratitis.All the eyes were examined by the slit lamp,followed by laser scanning confocal microscope,and then the 10％ KOH corneal smear was examined under the optical microscope.Results The positive rate of diagnosis was 75％ (125/167) by corneal scraping,and that by laser scanning confocal microscopy was 91％ (152/167).The positive rate of examining outcome was significantly higher in laser scanning confocal microscopy than that of corneal scraping (x2 =14.88,P =0.00).The positive results were 114 cases and negative results were 4 cases by two methods,with the concordance rate 70.7％ (118/167).The hyphae or spore were seen in 32 cases by laser scanning confocal microscopy in 42 negative cases by corneal scraping,and in 15 negative cases by confocal laser scanning microscopy,11 positive outcomes were offered by corneal scraping.Conclusions The combined application of corneal scraping with confocal laser scanning microscopy can improve and speed up the diagnosis positive rate of fungal keratitis.