聚合酶链反应在真菌性水(脓)疱诊断难辨认癣中的应用  

Application of polymerase chain reaction in the diagnosis of tinea incognito with fungal blisters or pustules

作　　者：夏慧 杨虹[2] 张鹏飞[2] 莫小辉 谭飞[1,2] XIA Hui;YANG Hong;ZHANG Pengfei;MO Xiaohui;TAN Fei(Clinical College of Shanghai Skin Disease Hospital, Anhui Medical University, Shanghai 200443, China;Shanghai Skin Disease Hospital of Tongji University, Shanghai 200443, China;Renji Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200127, China)

机构地区：[1]安徽医科大学上海皮肤病临床学院,上海200443 [2]同济大学附属皮肤病医院,上海200443 [3]上海交通大学医学院附属仁济医院,上海200127

出　　处：《中国真菌学杂志》2022年第2期115-119,128,共6页Chinese Journal of Mycology

基　　金：上海申康临床研究培育项目(SHDC12018X01)。

摘　　要：目的分析聚合酶链反应(polymerase chain reaction,PCR)在真菌性水(脓)疱诊断难辨认癣中的临床价值。方法纳入34例2020年7月—2021年10月就诊于我院(上海市皮肤病医院)门诊表现为水(脓)疱难辨认癣的患者,对34例患者的疱液标本进行PCR检测,并通过荧光染色镜检、真菌培养等进行对比。结果共收集34例患者的疱液标本,荧光染色镜检、真菌培养和PCR的敏感性分别为100%、77.8%和100%,特异性分别为87.5%、100%和75%,阳性预测值分别为90%、100%和81.8%,阴性预测值分别为100%、80%和100%,准确度分别为94.1%、88.2%和88.2%。疱液提取DNA、PCR扩增和测序比对在12 h内完成,鉴定出6种22例真菌(1例鉴定到属)。结论在真菌性水(脓)疱诊断难辨认癣中,PCR有较好的敏感性和准确度。PCR相较真菌镜检能判定真菌种类,相较真菌培养能缩短时间,能为难辨认癣的临床快速诊断与及时治疗提供参考价值。Objective To analyze the clinical value of polymerase chain reaction(PCR)in fungal blisters or pustules to diagnose tinea incognito.Methods From July 2020 to October 2021,thirty-four patients presenting tinea incognito with blisters or pustules in the outpatient department of our hospital(Shanghai Skin Disease Hospital)were included.PCR was performed in blister or pustule fluid specimens from 34 patients and compared by fluorescent staining microscopy and fungal culture.Results Blister or pustule fluid specimens were collected from a total of 34 patients.For fluorescent staining microscopy,fungal culture and PCR,the sensitivities were 100%,77.8%and 100%,the specificities were 87.5%,100%and 75%,the positive predictive values were 85.7%,100%and 75%,the negative predictive values were 100%,80%and 100%,the accuracy were 94.1%,88.2%and 88.2%,respectively.DNA extraction from blister or pustule fluid,PCR amplification and sequencing comparisons were completed within 12 hours,which identified six species and 22 cases of fungi(one case was identified to genus).Conclusion In the diagnosis of tinea incognito with fungal blisters or pustules,PCR has good sensitivity and accuracy.PCR can determine the fungal species compared with fluorescent staining microscopy and shorten the time compared to fungal culture,which can provide reference value for rapid clinical diagnosis and timely treatment of tinea incognito.

关 键 词：PCR 难辨认癣 疱液 菌种鉴定 

分 类 号：R756[医药卫生—皮肤病学与性病学]