Pritchard Nicola, Dehghani Cirous, Edwards Katie, Burgin Edward, Cheang Nick, Kim Hannah, Mikhaiel Merna, Stanton Gemma, Russell Anthony W, Malik Rayaz A, Efron Nathan
*Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; †School of Medicine, University of Queensland, St Lucia, Australia; ‡Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Australia; §Center for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom; and ¶Weill Cornell Medical College in Qatar, Doha, Qatar.
Cornea. 2015 Jul;34(7):756-61. doi: 10.1097/ICO.0000000000000447.
To compare small nerve fiber damage in the central cornea and whorl area in participants with diabetic peripheral neuropathy (DPN) and to examine the accuracy of evaluating these 2 anatomical sites for the diagnosis of DPN.
A cohort of 187 participants (107 with type 1 diabetes and 80 controls) was enrolled. The neuropathy disability score (NDS) was used for the identification of DPN. The corneal nerve fiber length at the central cornea (CNFLcenter) and whorl (CNFLwhorl) was quantified using corneal confocal microscopy and a fully automated morphometric technique and compared according to the DPN status. Receiver operating characteristic analyses were used to compare the accuracy of the 2 corneal locations for the diagnosis of DPN.
CNFLcenter and CNFLwhorl were able to differentiate all 3 groups (diabetic participants with and without DPN and controls) (P < 0.001). There was a weak but significant linear relationship for CNFLcenter and CNFLwhorl versus NDS (P < 0.001); however, the corneal location × NDS interaction was not statistically significant (P = 0.17). The area under the receiver operating characteristic curve was similar for CNFLcenter and CNFLwhorl (0.76 and 0.77, respectively, P = 0.98). The sensitivity and specificity of the cutoff points were 0.9 and 0.5 for CNFLcenter and 0.8 and 0.6 for CNFLwhorl.
Small nerve fiber pathology is comparable at the central and whorl anatomical sites of the cornea. Quantification of CNFL from the corneal center is as accurate as CNFL quantification of the whorl area for the diagnosis of DPN.
比较糖尿病周围神经病变（DPN）患者中央角膜和螺旋区的小神经纤维损伤情况，并检验评估这两个解剖部位对DPN诊断的准确性。
纳入187名参与者（107名1型糖尿病患者和80名对照者）。采用神经病变残疾评分（NDS）来识别DPN。使用角膜共焦显微镜和全自动形态测量技术对中央角膜（CNFLcenter）和螺旋区（CNFLwhorl）的角膜神经纤维长度进行量化，并根据DPN状态进行比较。采用受试者工作特征分析来比较两个角膜部位对DPN诊断的准确性。
CNFLcenter和CNFLwhorl能够区分所有3组（有和无DPN的糖尿病参与者及对照者）（P < 0.001）。CNFLcenter和CNFLwhorl与NDS之间存在微弱但显著的线性关系（P < 0.001）；然而，角膜部位×NDS的交互作用无统计学意义（P = 0.17）。CNFLcenter和CNFLwhorl的受试者工作特征曲线下面积相似（分别为0.76和0.77，P = 0.98）。CNFLcenter的截断点敏感性和特异性分别为0.9和0.5，CNFLwhorl的分别为0.8和0.6。
角膜中央和螺旋区解剖部位的小神经纤维病变情况相当。从角膜中央量化CNFL对DPN诊断的准确性与螺旋区CNFL量化相同。
