[基于共焦生物显微镜技术的糖尿病角膜神经纤维形态测量新方法]

Avetisov S E, Novikov I A, Makhotin S S, Surnina Z V

Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991.

Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021.

Vestn Oftalmol. 2015 Jul-Aug;131(4):5-14. doi: 10.17116/oftalma201513145-14.

AIM

to develop a new approach to morphometric analysis of corneal nerve fibers (CNF) and to evaluate their age-related changes in type 1 and type 2 diabetes mellitus patients.

MATERIAL AND METHODS

The study enrolled 150 participants (300 eyes) aged from 13 to 83 years, of them 37 type 1 diabetes patients (74 eyes), 51 type 2 diabetes patients (102 eyes), and 62 healthy volunteers (124 eyes). All participants were examined with HRT III Rostock Corneal Module (Heidelberg Engineering GmbH). Digital images thus obtained were analyzed with specially developed original software that automatically computes coefficients of CNF orientation symmetry and anisotropy.

RESULTS

A strong inverse correlation has been found between the coefficient of CNF orientation anisotropy and glycated hemoglobin levels (r = -0.83, p < 0.001 and r = -0.79, p < 0.005 in patients with type 1 and type 2 diabetes respectively) as well as the duration of the disease (r = -0,7, p < 0.005 and r = -0.72, p < 0.001, type 1 and type 2 diabetes respectively). On the contrary, the coefficient of CNF orientation symmetry has been shown to be directly correlated with both glycated hemoglobin levels (r = 0.64, p < 0.005 and r = 0.78, p < 0.05, type 1 and type 2 diabetes respectively) and the duration of the disease (r = 0.62, p < 0.05 and r = 0.73, p < 0.05, type 1 and type 2 diabetes respectively). Interocular asymmetry in both coefficients was found in diabetic patients but not in the controls. On the basis of the proposed coefficients, age-related changes in corneal nerve fibers orientation have been determined. Normally, the degree of CNF tortuosity increases with age. The rate of this increase is the highest before the age of 35-40. As shown, type 1 diabetes is associated with low coefficients of CNF orientation anisotropy and high coefficients of CNF orientation symmetry as compared to type 2 diabetes in the same age group.

CONCLUSION

As suggested by the results, the two proposed coefficients that describe the state of corneal nerve fibers can possibly be used for diagnosis and monitoring of diabetic peripheral neuropathy (DPN). However, to produce enough evidence, further studies should be conducted.

目的

开发一种角膜神经纤维（CNF）形态计量分析的新方法，并评估1型和2型糖尿病患者中CNF与年龄相关的变化。

材料与方法

该研究纳入了150名年龄在13至83岁之间的参与者（300只眼睛），其中37名1型糖尿病患者（74只眼睛），51名2型糖尿病患者（102只眼睛），以及62名健康志愿者（124只眼睛）。所有参与者均使用HRT III Rostock角膜模块（海德堡工程有限公司）进行检查。对由此获得的数字图像使用专门开发的原始软件进行分析，该软件可自动计算CNF方向对称性和各向异性系数。

结果

已发现CNF方向各向异性系数与糖化血红蛋白水平（1型糖尿病患者中r = -0.83，p < 0.001；2型糖尿病患者中r = -0.79，p < 0.005）以及病程（1型糖尿病患者中r = -0.7，p < 0.005；2型糖尿病患者中r = -0.72，p < 0.001）呈强烈负相关。相反，CNF方向对称性系数与糖化血红蛋白水平（1型糖尿病患者中r = 0.64，p < 0.005；2型糖尿病患者中r = 0.78，p < 0.05）以及病程（1型糖尿病患者中r = 0.62，p < 0.05；2型糖尿病患者中r = 0.73，p < 0.05）均呈正相关。在糖尿病患者中发现了这两个系数的双眼不对称性，而在对照组中未发现。基于所提出的系数，已确定了角膜神经纤维方向与年龄相关的变化。正常情况下，CNF的弯曲程度随年龄增加。在35 - 40岁之前这种增加速率最高。结果表明，在同一年龄组中，与2型糖尿病相比，1型糖尿病与较低的CNF方向各向异性系数和较高的CNF方向对称性系数相关。