Zhang Y, Wang Z Q, Deng S J, Tian L, Liang Q F
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2019 Aug 11;55(8):601-608. doi: 10.3760/cma.j.issn.0412-4081.2019.08.010.
To analyze the sensitivity and specificity of fungal fluorescent staining in the diagnosis of fungal keratitis, and to compare it with conventional fungal culture, confocal microscopy (IVCM) and Giemsa staining. To explore its value of clinical application. Prospective case-control study. A total of 105 consecutive patients (105 eyes) diagnosed with infectious keratitis at Beijing Tongren Hospital from August 2017 to April 2018 were included. Patients with infectious keratitis were divided into fungal keratitis (FK) group and non-fungal keratitis (NFK) group by slit lamp microscopy, corneal in vivo confocal microscopy (IVCM) examination, and the results of Giemsa staining, fluorescent staining and pathogenic culture of corneal scraping from ulcer. The sensitivity and specificity of the above-mentioned examination methods for the diagnosis of fungal keratitis were analyzed. The receiver operating characteristic curve (ROC curve) and Area Under Curve (AUC) values were calculated to determine the diagnostic value of fungal fluorescent staining for fungal keratitis. Among the 105 patients with infectious keratitis, 66 were fungal keratitis, 39 were non-fungal keratitis (29 cases of bacterial keratitis and 10 cases of acanthamoeba keratitis). Isolation from fungal keratitis were mainly . (43.5%), followed by . (21.7%) and (19.6%). After fluorescent staining of the ulcer smear, the background of tissue demonstrated homogeneous black or weak blue fluorescence. The cell wall of fungi showed bright blue-violet to blue fluorescence, and the morphology, structure and hyphal density were easily recognized. The sensitivity of different methods for the diagnosis of corneal fungal infection were smear fluorescence staining (97.0%), IVCM (87.9%) , Giemsa staining (86.7%), and fungal culture (69.7%); the specificity of fungal culture was the highest (100%), followed by IVCM and Giemsa staining (94.9%), and fluorescent staining (87.2%). The ascending order of AUC values was: fungal culture (0.848) <Giemsa staining (0.906) <IVCM (0.914) <fluorescence staining (0.921). Fungal fluorescent staining is a rapid and sensitive screening method under microscope with high sensitivity and specificity for the diagnosis of fungal keratitis. It is especially suitable for the diagnosis of patients with low load of hypha or after antifungal therapy. .
分析真菌荧光染色在真菌性角膜炎诊断中的敏感性和特异性，并与传统真菌培养、共焦显微镜检查（IVCM）及吉姆萨染色进行比较。探讨其临床应用价值。前瞻性病例对照研究。纳入2017年8月至2018年4月在北京同仁医院连续诊断为感染性角膜炎的105例患者（105只眼）。通过裂隙灯显微镜检查、角膜共焦显微镜（IVCM）检查以及溃疡角膜刮片的吉姆萨染色、荧光染色和病原培养结果，将感染性角膜炎患者分为真菌性角膜炎（FK）组和非真菌性角膜炎（NFK）组。分析上述检查方法诊断真菌性角膜炎的敏感性和特异性。计算受试者工作特征曲线（ROC曲线）及曲线下面积（AUC）值，以确定真菌荧光染色对真菌性角膜炎的诊断价值。在105例感染性角膜炎患者中，真菌性角膜炎66例，非真菌性角膜炎39例（细菌性角膜炎29例，棘阿米巴角膜炎10例）。真菌性角膜炎分离株主要为……（43.5%），其次为……（21.7%）和……（19.6%）。溃疡涂片荧光染色后，组织背景呈均匀黑色或淡蓝色荧光。真菌细胞壁呈亮蓝紫色至蓝色荧光，形态、结构及菌丝密度易于识别。不同方法诊断角膜真菌感染的敏感性分别为涂片荧光染色（97.0%）、IVCM（87.9%）、吉姆萨染色（86.7%）、真菌培养（69.7%）；真菌培养的特异性最高（100%），其次为IVCM和吉姆萨染色（94.9%），荧光染色（87.2%）。AUC值升序排列为：真菌培养（0.848）＜吉姆萨染色（0.906）＜IVCM（0.914）＜荧光染色（0.921）。真菌荧光染色是一种快速、敏感的显微镜下筛查方法，对真菌性角膜炎诊断具有较高的敏感性和特异性。尤其适用于菌丝负荷低或抗真菌治疗后的患者诊断。
