Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
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Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot

당뇨병환자의 족부 진균 질환 유병률과 당뇨병성 족부질환과의 상관성 조사

Cha, Bong-Yun;Son, Hyun-Shik;Lee, Jung-Min;Kang, Sung-Koo
차봉연;손현식;이정민;강성구

  • Published : 2006.01.31
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Abstract

Background: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. Methods: A total of 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed by a dermatologist. Results: 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease was found in 10,403 patients that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), nonpalpable pulse in 1,051 (4.8%; 7.9%), and foot ulcer was in 425 (2.0%; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid visit to the department of dermatology. Of these, 4,519 patient were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population were comprised of 2,272 males and 2,247 females, showing similar prevalences between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 (70%) and onychomycosis was proven mycologically in 3,276 patients. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885 (70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles. Conclusion: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

배경 및 방법: 2001년 3월부터 9월까지 전국의 32개 전공의 수련병원 내분비내과에 내원하여 당뇨병으로 진단받은 21,693명을 대상으로 족부질환을 조사하고 족부 피부질환이 의심되는 환자는 피부과로 의뢰되어 피부과 의사의 이학적 검사 및 KOH 진균 도말검사를 실시하여 당뇨병환자에서 족부 진균감염의 유병률을 알아보고 족부궤양과의 상관성을 비교하였다. 결과: 전체 21,693명의 환자 중 61.2%인 13,271명이 족부질환이 있었고 족부 질환 환자 가운데 족부 진균 감염은 10,403명으로 전체의 48.0% (전체 족부 질환의 78.4%)였고 족부백선이 6,496명 (29.9%), 조갑진균증이 7,783명(35.9%), 두 질환이 함께 있는 경우가 3,883명 (17.9%)이었다. 족부궤양은 425명으로 전체의 2% (족부질환의 3.2%)였고 맥박이 촉지가 되지 않는 경우 (미촉지 맥박)가 1,051명으로 전체의 4.8% (족부질환의 7.9%)였으며 족부기형은 1,346명으로 6.2% (족부질환의 10.1%)였다. 족부기형이 있는 경우가 없는 경우에 비해 2.5배 진균감염의 발생빈도가 높았고 족부 궤양이 있는 경우에 없는 경우에 비해 1.6배 진균 감염이 더 흔히 발생하였다. 족부 궤양은 족부 기형과 족부 진균감염이 있거나 미촉지 맥박이 있는 경우에 그렇지 않은 경우와 비교하여 각각 1.6배, 2.5배, 2.2배 족부궤양이 잘 생기는 것으로 나타났다. 피부과에 내원한 환자 5,486명에서 임상소견, KOH 도말검사를 통해 진균감염이 확진된 환자는 4,519명이었다. 족부 진균감염의 빈도는 남자에서 2,272명, 여자에서 2,247명으로 남녀간에 유의한 차이가 없었다. 족부 진균감염과 나이 간의 상관관계에 있어서는 나이가 증가할수록 통계적으로 유의하게 진균감염이 증가하는 것으로 나타났다. 이학적 검사에서 조갑에 이상이 있는 환자는 3,847명(70%)이었고 진균검사로 확진된 조갑진균증 환자는 3,276명이었으며 원위조갑하형태가 가장 흔하였고 엄지발톱에 가장 많이 발생하였다. 족부 피부의 이상은 5,486명중 3,885명 (70.8%)에서 관찰되었으며 족부백선이 3,209명(58.5%)이었고 발바닥에 가장 흔히 발생하였다. 결론: 이상의 결과로 당뇨병환자에서 족부 궤양의 위험인자로서 진균감염이 상관성이 있음을 알 수 있었다. 따라서 당뇨병환자에서 족부 진균감염의 치료가 족부 궤양과 같은 당뇨병성 족저질환을 예방하여 환자의 장애나 불구, 치명률을 감소시켜 줄 것으로 생각된다.

Keywords

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