MYCOSIS-INDUCED NAIL INGROWTH IN PATIENTS WITH DIABETES MELLITUS AND METABOLIC SYNDROME: APPROACHES TO THE PROBLEM
The study involves peculiarities of treatment, some indicators of lipid exchange in patients with diabetes mellitus, metabolic syndrome accompanied by destructive onychomycosis and secondary ingrown nail. Clinical options of in-patient and outpatient surgical treatment for nail ingrowth (mono-lesions; complicated and combined mycotic-associated processes and relapses) were clarifi ed; morphologic changes were studied; causes of unsatisfactory outcomes of chronic pathology complex treatment were analyzed for prospective approaches to preventing relapses. Along with antimycotic therapy and correction of comorbid pathology the following procedures were carried out: cutting pathologic eponychial tissues, hypergranulations and necroses; removing nail plate with partial marginal matrixectomy in the ingrowth area. Non-invasive methods of nail excision and marginal nail resection were preferred in patients with diabetes mellitus. The prospective study involved 403 patients (48-72 aged) with complicated mycotic damage, nail ingrowth. Polyonychomycosis and trichophytic subungual hyperkeratosis with secondary ingrown nail were diagnosed in the main group comprising 62 patients with type 2 diabetes mellitus (48 males and 14 females, 42-65 aged). Metabolic syndrome was confi rmed in the comparison group comprising 53 patients with arterial hypertension and complicated mycotic nail damage. The rest 276 patients made up the control group. We studied biochemical indicators, lipid blood spectrum: total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol; nitric oxide of blood plasma; leptin. Lipid blood spectrum and nitric oxide level were determined before and after pharmacotherapy along with continuous antihypertensive therapy (correction of intercurrent and comorbid pathology). The objective criterion of insulin resistance was NOMA-IP index (the Homeostasis Model Assessment) involving glucose and insulin levels on an empty stomach divided by 22,5 coeffi cient. Patients of the main and the comparison groups with polyohychomycosis and trichophytic subungual hyperkeratosis with secondary nail ingrowth experienced considerable decreasing NOMA-index of β-cells function and increasing NOMAindex of insulin resistance (8,11±1,1 in the main group, 5,89±2,1 in the comparison group and 2,23±1,18 in the control group, p1<0,01; p2<0,01). Considerable positive correlation between all indicators of carbohydrate exchange was identifi ed in groups comprising patients with type2 diabetes mellitus: glucose and insulin (r=0,51; p<0,01), with NOMA-index (r=0,70; p<0,01), with glycolyzed hemoglobin (r=0,75; p<0,001); insulin with NOMA-index (r=0,73; p<0,01) and glycolyzed hemoglobin (r=0,65; p<0,01); NOMA-index with glycolyzed hemoglobin (r=0,67; p<0,01). Considerable increasing of circulating insulin was identifi ed directly after surgical treatment (in the main group and the comparison group correspondingly 15,33±1,12 and 8,24±1,18 mkMO/l, p<0,01), NOMA-index of insulin resistance (p<0,05) and NOMA-index of β-cells function (p<0,05) in comparison with the control group with further tendency to some decrease in the process of treatment. We determined disturbances in lipid exchange, insulin resistance, lipid blood spectrum changes that were considerably higher in both groups of patients (main and comparison groups), p<0,01 for both groups in comparison with the control group.
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