真菌性角膜炎实验室诊断方法的对比分析  

Contrast analysis of laboratory diagnosis of fungal keratitis

作　　者：陈薇婴[1] 

机构地区：[1]天津医科大学眼科临床学院,天津市眼科医院,天津市眼科学与视觉科学重点实验室,天津300020

出　　处：《中国实用眼科杂志》2015年第6期617-620,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的进行真菌刮片、真菌培养、共聚焦激光显微镜和角膜病理学检查的对比分析，以期找出理想的实验室诊断方法协助临床的治疗。方法实验方法对比研究。对2009年2月至2013年10月在天津市眼科医院拟诊为真菌性角膜炎的患者141例，进行真菌刮片、真菌培养、共聚焦激光显微镜和角膜病理学检查。结果141例患者中真菌刮片直接镜检查到菌丝109例，刮片阳性率为77．3％（109／141）。真菌培养共检出真菌104株，阳性率为73．8％（104／141）。通过对141例患者进行共聚焦激光显微镜检查，133例在显微镜下直接观察到菌丝，阳性率为94.3％（133／141）。对患者切除其角膜溃疡组织进行特染及酶组化染色分析，124例患者中56例在切片中观察到PAS染色阳性的真菌菌丝，阳性率为45％（56／124）。共聚焦激光显微镜检查阳性率远高于真菌刮片直接镜检阳性率（X2=16．72，P〈0．01）、真菌培养阳性率（r=22．10，P〈O．01）和角膜组织病理PAS染色阳性率（X2=78．25，P〈O．01）。结论共聚焦激光显微镜检查阳性率高且可在不损伤角膜的情况下进行观察，但较难鉴别真菌种类。真菌刮片直接镜检，快速简便，但刮取的角膜深浅程度和操作者的经验直接影响阳性检出率，可造成假阴性或假阳性的结果并且对角膜损伤较大。真菌培养所需时间较长，一般要7天左右的时间，但可进行药物敏感性实验，以指导临床用药。建议在未进行角膜刮片和任何药物治疗的情况下进行共聚焦激光显微镜检查，然后再进行真菌刮片直接镜检和真菌培养，病理检查不宜用于临床常规检查方法。Objective To find out ideal laboratory diagnosis methods by contrast analysis of fun- gus scraping, fungus culture, confocal laser microscope and histopathologic assessment. Methods Fungus scraping, fungus culture, confocal laser microscope and histopathologic assessment were per- formed on 115 patients of suspected fungal keratitis. Results The positive rate of confocal laser mi- croscopy was 94.3% （133/141）. The positive rate of corneal tissue smears was 77.3% （109/141）. The positive rate of fungus cultivation was 73.8% （104/141）. The positive rate of histopathologic assess- ment was 45% （56/124）. The positive rate of fungal keratitis detected by confocal laser corneal mi- croscopy was higher than by corneal tissue smears （,V=16.72, P 〈0.01）, fungal cultivation （Z~=22.10, P 〈0.01） and histopathologic assessment （Z2=78.25, P 〈0.01）. Conclusions Confocal laser micro- scope technique has high positive rate and can be noninvasive method, but it is difficult to identify the strain of fungus. Fungus scraping is rapid but its positive rate is influenced by shade degree of comea and operator＇s experiences and can be result in false positive and false negative and damage cornea. Fungus culture needs long time for about seven days but can carry out drug sensitivity ex- periment and can direct clinical medication. It is suggestion that confocal laser comeal microscopy examination can be carry out before fungus scraping and clinical medication. Histopathologic assess- ment is not suitable for clinical routine examination.

关 键 词：真菌性角膜炎 共聚焦激光显微镜 真菌培养 真菌刮片 

分 类 号：R772.21[医药卫生—眼科]