| Objective:1. To observe and compare the difference clinical type and pathogens of onychomycosis between diabetic patients and the general population without diabetes.2. To investigate the correlation between the onychomyosis and the characteristics of patients with diabetes can help us to understand the etiology mechanism of onychomycosis,in diabetic patients and found systemic disease early. The study is important and provides reasonable information for selecting antifungal drugs on the treatment of diabetic patients with onychomyosis. It can also improve the cure rate; reduce the recurrence rate.3. To determine the sensitivity and specificity of Bst U I restriction endonuclease by PCR-PELP molecular biology methods and to improve the accuracy rate of onychomyosis diagnosis, short the identification time of pathogentic fungal.Methods:1125 patients of type 2 diabetes diagnosed in the department of endocrinology were collected and analyzed retrospectively as experimental group in our hospital from June2013 to December 2014, and 552 patients for the physical examination without diabetes were analyzed as control group. The informed consent was signed by all patients. The patients’ characteristic were collected by the questionnaire which included sex, age,diabetes duration, random blood glucose and the level of glycosylated hemoglobin, with or without circulatory disordery(intermittent claudication, dorsalis pedis artery pulse wave weakened or disappeared, acromegaly ulcer or necrosis), with or without peripheral neuropathy( sensory impairment or sensory disturbance), with or withoutretinopathy(decreased visual acuity, fundus exudation or bleeding), hypertension and so on.The univariate and multivariate Logistic regression methods were carried out to analyze the relationship between the patients’ characteristics and onychomycosis using SPSS 21.0.Software. To collect the nail sample of experimental group, observe the sample on the microscopic and culture the sample on SDA medium. Then the DNA of isolates were amplify use PCR, The sequences were blast to confirm and identificate. In order to observe the sensitivity and specificity of Bst U I enzyme, clinical isolates were identified using polymerase chain reaction-restriction fragment length polymorphism(RFLP).Results:1. The risk of suffering from onychomycosis in experimental group was 2.68 times higher than the control group, and 153 patients and 161 nails of onychomycosis in experimental group were found and the incidence was 13.6%. The positive rate of microscopy(77.3%), the positive rate of culture(70.8%). The clinical typing of onychomycosis is dominated by DLSO, 94 cases(58.39%), 77 cases were infected by dermatophytes as the main pathogenic strains(67.54%); 28 cases of onychomycosis were found in control group, the incidence of onychomycosis was 5.07%, 32 nails were infected by fungal, type and pathogenic strain of onychomycosis in experimental group are consistent with control group, respectively is DLSO type, 17 cases(53.13%), 15 cases of dermatophytes(53.57%).2. Single factor analysis showed that the risk of elderly, male, duration of diabetes,peripheral circulatory disorders, diabetic peripheral neuropathy was higher to infect onychomycosis(P<0.05). Multivariate Logistic regression analysis showed that diabetic patients with age increased(P<0.05), male(P<0.05), diabetes duration(P<0.05),peripheral circulatory disorders(P<0.05), peripheral neuropathy(P<0.05), retinopathy(P<0.05) are susceptible factors of onychomycosis.3. Dermatophytes genera, aspergillus and yeast can be distinguished by the restriction endonuclease Bst U I using PCR-RFLP, the Bst U I should be used more in clinical work.Conclusion:1. The results of this study showed that the incidence of onychomycosis in diabetic patients is higher than people without diabetes.2. DLSO is still the main clinical type and Trichophyton rubrum is still the dominant pathogens of diabetes mellitus with onychomycosis.3. Multivariate analysis showed that male, elderly, duration of diabetes, peripheral neuropathy, peripheral circulatory disorders were independent risk factors associated with onychomycosis.4. Dermatophytes genera, aspergillus and yeast can be distinguished rapidly and accurately by the restriction endonuclease Bst U I using in the method of PCR-RFLP. To some extent it reduces the cost and time of the test, and it is worth to widely use in clinic. |
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