Azmi Shazli, Ferdousi Maryam, Alam Uazman, Petropoulos Ioannis N, Ponirakis Georgios, Marshall Andrew, Asghar Omar, Fadavi Hassan, Jones Wendy, Tavakoli Mitra, Boulton Andrew J M, Jeziorska Maria, Soran Handrean, Efron Nathan, Malik Rayaz A
Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, 46 Grafton Street, Core Technology Facility, Manchester, M13 9NT, UK.
Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Diabetologia. 2017 Jun;60(6):1094-1101. doi: 10.1007/s00125-017-4245-z. Epub 2017 Mar 29.
AIMS/HYPOTHESIS: The aim of this study was to identify the contribution of small- and large-fibre neuropathy to erectile dysfunction in men with type 1 diabetes mellitus.
A total of 70 participants (29 without and 41 with erectile dysfunction) with type 1 diabetes and 34 age-matched control participants underwent a comprehensive assessment of large- and small-fibre neuropathy.
The prevalence of erectile dysfunction in participants with type 1 diabetes was 58.6%. After adjusting for age, participants with type 1 diabetes and erectile dysfunction had a significantly higher score on the Neuropathy Symptom Profile (mean ± SEM 5.3 ± 0.9 vs 1.8 ± 1.2, p = 0.03), a higher vibration perception threshold (18.3 ± 1.9 vs 10.7 ± 2.4 V, p = 0.02), and a lower sural nerve amplitude (5.0 ± 1.1 vs 11.7 ± 1.5 mV, p = 0.002), peroneal nerve amplitude (2.1 ± 0.4 vs 4.7 ± 0.5 mV, p < 0.001) and peroneal nerve conduction velocity (34.8 ± 1.5 vs 41.9 ± 2.0 m/s, p = 0.01) compared with those without erectile dysfunction. There was also evidence of a marked small-fibre neuropathy with an impaired cold threshold (19.7 ± 1.4°C vs 27.3 ± 1.8°C, p = 0.003), warm threshold (42.9 ± 0.8°C vs 39.0 ± 0.9°C, p = 0.005) and heart rate variability (21.5 ± 3.1 vs 30.0 ± 3.7 beats/min, p = 0.001) and reduced intraepidermal nerve fibre density (2.8 ± 0.7 vs 5.9 ± 0.7/mm, p = 0.008), corneal nerve fibre density (12.6 ± 1.5 vs 23.9 ± 2.0/mm, p < 0.001), corneal nerve branch density (12.7 ± 2.5 vs 31.6 ± 3.3/mm, p < 0.001) and corneal nerve fibre length (8.3 ± 0.7 vs 14.5 ± 1.0 mm/mm, p < 0.001) in participants with type 1 diabetes and erectile dysfunction. Erectile dysfunction correlated significantly with measures of both large- and small-fibre neuropathy.
CONCLUSIONS/INTERPRETATION: Small-fibre neuropathy is prominent in patients with type 1 diabetes, and is associated with erectile dysfunction and can be objectively quantified using corneal confocal microscopy. This may allow the identification of patients who are less likely to respond to conventional therapies such as phosphodiesterase type 5 inhibitors.
目的/假设：本研究旨在确定小纤维和大纤维神经病变对1型糖尿病男性勃起功能障碍的影响。
共有70名1型糖尿病患者（29名无勃起功能障碍，41名有勃起功能障碍）和34名年龄匹配的对照参与者接受了大纤维和小纤维神经病变的综合评估。
1型糖尿病患者勃起功能障碍的患病率为58.6%。在调整年龄后，患有1型糖尿病且有勃起功能障碍的参与者在神经病变症状量表上的得分显著更高（均值±标准误 5.3±0.9 对1.8±1.2，p = 0.03），振动觉阈值更高（18.3±1.9对10.7±2.4V，p = 0.02），腓肠神经振幅更低（5.0±1.1对11.7±1.5mV，p = 0.002），腓总神经振幅更低（2.1±0.4对4.7±0.5mV，p < 0.001），腓总神经传导速度更低（34.8±1.5对41.9±2.0m/s，p = 0.01），与无勃起功能障碍的参与者相比。也有证据表明存在明显的小纤维神经病变，表现为冷觉阈值受损（19.7±1.4°C对27.3±1.8°C，p = 0.003）、温觉阈值受损（42.9±0.8°C对39.0±0.9°C，p = 0.005）、心率变异性降低（21.5±3.1对30.0±3.7次/分钟，p = 0.001）以及表皮内神经纤维密度降低（2.8±0.7对5.9±0.7/mm，p = 0.008）、角膜神经纤维密度降低（12.6±1.5对23.9±2.0/mm，p < 0.001）、角膜神经分支密度降低（12.7±2.5对31.6±3.3/mm，p < 0.001）和角膜神经纤维长度降低（8.3±0.7对14.5±1.0mm/mm，p < 0.001），这些均出现在患有1型糖尿病且有勃起功能障碍的参与者中。勃起功能障碍与大纤维和小纤维神经病变的测量指标均显著相关。
结论/解读：小纤维神经病变在1型糖尿病患者中较为突出，与勃起功能障碍相关，并且可以通过角膜共焦显微镜进行客观量化。这可能有助于识别那些对传统疗法（如5型磷酸二酯酶抑制剂）反应较小的患者。
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