Fletcher C L, Hay R J, Smeeton N C
St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH.
Br J Dermatol. 2004 Apr;150(4):701-5. doi: 10.1111/j.0007-0963.2004.05871.x.
The ideal method for diagnosing onychomycosis is unclear. Mycological investigation is currently the method of choice, although there is a false-negative culture rate of at least 30%.
To establish a clinical diagnostic aid which may be used alongside laboratory-based mycological tests and in epidemiological studies.
Patients with nail disease (n = 209) were enrolled in the study. The examining clinician completed a questionnaire containing four historical questions and 21 questions related to the clinical findings. All patients had samples taken for mycological analysis. The gold standard for the diagnosis of onychomycosis was a positive result on both direct microscopy and culture of nail samples. Following exclusions, questionnaire responses from 169 patients were analysed using Stata. Multiple logistic regression with forward stepwise selection of variables was performed.
Both microscopy and culture results were positive in 32% of cases and negative in 42%. Dermatophytes formed the majority of isolates. Four parameters were found to be significantly related to positive mycology results: a history of tinea pedis in the last year, scaling on one or both soles, white crumbly patches on the nail surface, and an abnormal colour of the nail plate.
Our results have shown one historical feature and three clinical features to be strongly associated with onychomycosis. The questionnaire has been revised to include only these stems and is being tested further with the aim of achieving a binary definition.
诊断甲癣的理想方法尚不清楚。目前，真菌学检查是首选方法，尽管其培养假阴性率至少为30%。
建立一种可与基于实验室的真菌学检测一起用于临床诊断辅助以及流行病学研究的方法。
招募了209名患有指甲疾病的患者参与研究。检查的临床医生完成了一份包含四个病史问题和21个与临床发现相关问题的问卷。所有患者均采集样本进行真菌学分析。甲癣诊断的金标准是指甲样本直接显微镜检查和培养结果均为阳性。排除后，使用Stata对169名患者的问卷回复进行分析。进行了向前逐步选择变量的多因素逻辑回归分析。
32%的病例显微镜检查和培养结果均为阳性，42%为阴性。皮肤癣菌是分离出的主要菌种。发现有四个参数与真菌学阳性结果显著相关：过去一年有足癣病史、一侧或双侧脚底有鳞屑、指甲表面有白色碎屑斑以及甲板颜色异常。
我们的结果表明，一个病史特征和三个临床特征与甲癣密切相关。问卷已修订，仅包含这些问题，并正在进一步测试，以期实现二元定义。
