Navarro-Pérez David, Lázaro-Martínez José Luis, García-Oreja Sara, Pérez-Pérez Teresa, Álvaro-Afonso Francisco Javier, Tardáguila-García Aroa
Diabetic Foot Unit, University Podiatric Clinic, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain.
San Carlos Clinical Hospital Health Research Institute (IdISSC), 28040 Madrid, Spain.
J Fungi (Basel). 2024 Nov 14;10(11):790. doi: 10.3390/jof10110790.
A cross-sectional study was conducted to investigate the prevalence of onychomycosis (ONM) and its causative pathogens in populations with and without diabetes in Spain. The association between the presence of ONM, different risk factors, and comorbidities was also examined.
A total of 160 patients with diabetes and 160 individuals without diabetes were recruited consecutively. A single investigator recorded the relative data of each patient and sampled nail dust and detritus for microbiological culture and polymerase chain reaction (PCR) analyses of patients who showed clinical signs of fungal infection.
The prevalence of ONM was 36.88% (59/160) in the population with diabetes, 17.5% (28/160) in the population without diabetes, and 34.35% (45/131) in the population with diabetic foot. Dermatophyte fungi were most frequently identified, although the proportion was higher among those without diabetes than those with diabetes (19/28 and 28/59, respectively). However, the rate of mixed infections was higher in the population with diabetes compared to those without diabetes (13/59 and 2/28, respectively). A statistically significant association was found between the presence of diabetes and the risk of ONM ( < 0.001; odds ratio (OR) = 2.754; 95% confidence interval (CI) 1.652-4.679). The risk factors associated with ONM among the patients with diabetes were a history of minor amputation, revascularisation, or cardiovascular disease, a low educational level, HbA1c values > 7%, hyperkeratosis, and subungual detritus. Among the patients without diabetes, nail thickening and chromonychia were associated with ONM.
The results of this study suggest that the early diagnosis of ONM and knowledge of risk factors among patients with diabetes could enable the prevention of ONM, complications, and serious injuries through education for professionals and patients.
开展了一项横断面研究，以调查西班牙糖尿病患者和非糖尿病患者中灰指甲（甲癣，ONM）的患病率及其致病病原体。还研究了甲癣的存在、不同风险因素与合并症之间的关联。
连续招募了160例糖尿病患者和160例非糖尿病个体。由一名研究人员记录每位患者的相关数据，并对表现出真菌感染临床症状的患者采集指甲屑和碎屑样本，进行微生物培养和聚合酶链反应（PCR）分析。
糖尿病患者中甲癣的患病率为36.88%（59/160），非糖尿病患者中为17.5%（28/160），糖尿病足患者中为34.35%（45/131）。虽然最常鉴定出皮肤癣菌，但非糖尿病患者中的比例高于糖尿病患者（分别为19/28和28/59）。然而，糖尿病患者中的混合感染率高于非糖尿病患者（分别为13/59和2/28）。发现糖尿病的存在与甲癣风险之间存在统计学显著关联（<0.001；比值比（OR）=2.754；95%置信区间（CI）1.652 - 4.679）。糖尿病患者中甲癣相关的风险因素包括小截肢、血管重建或心血管疾病史、低教育水平、糖化血红蛋白（HbA1c）值>7%、角化过度和甲下碎屑。在非糖尿病患者中，指甲增厚和甲变色与甲癣有关。
本研究结果表明，对甲癣的早期诊断以及对糖尿病患者风险因素的了解，可通过对专业人员和患者的教育来预防甲癣、并发症和严重损伤。
