Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China.
Jing'an Temple Street Community Health Service Center, Shanghai 200040, China.
Diabetes Res Clin Pract. 2018 Feb;136:85-92. doi: 10.1016/j.diabres.2017.11.026. Epub 2017 Dec 6.
To evaluate the efficacy of corneal confocal microscopy (CCM) as a non-invasive test to assess diabetic peripheral neuropathy in Chinese patients diagnosed with type 2 diabetes.
Diabetic distal symmetric polyneuropathy (DSPN) and its severity degrees were assessed based on the modified Toronto diagnostic criteria in 128 patients with type 2 diabetes (No DSPN [n = 49], mild DSPN [n = 43], moderate-to-severe DSPN [n = 36]) and 24 age-matched controls. CCM was also examined in all enrolled subjects. Corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD) and corneal nerve fiber density (CNFD) were analyzed by Fiji imaging analysis software. The efficacy of CCM as a non-invasive test to assess diabetic peripheral neuropathy was determined.
CNFL was 17.99 ± 0.66, 15.82 ± 0.64, 14.98 ± 0.63, and 12.49 ± 0.93 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNFL in type 2 diabetes patients with no, mild, and moderate-to-severe DSPN demonstrated a significant reduction than in healthy controls (P = .012, .003 and <.001, respectively). CNFL in patients with moderate-to-severe DSPN was significantly shorter than in patients with no or mild DSPN (P < .001 and .004, respectively). CNBD was 41.48 ± 3.35, 33.02 ± 2.50, 30.91 ± 2.33, and 18.00 ± 2.33 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNBD in healthy control was significantly higher than in type 2 diabetes patients with no, mild, and moderate-to-severe DSPN (P = .036, 0.016 and < .001, respectively). CNBD in patients with moderate-to-severe DSPN was significantly lower than in patients with no or mild DSPN (P < .001 for both). CNFD was 35.32 ± 1.18, 35.68 ± 1.10, 34.54 ± 1.12, and 32.28 ± 1.76 in healthy controls, T2DM patients with no, mild, and moderate-to-severe DPN, respectively. CNFD did not differ among the four groups. In an analysis that divided CNFL, CNFD and CNBD into quartiles, there were no significant differences in electromyography findings and vibration perception threshold among the 4 groups; however, significant differences were seen in the positive distribution of temperature perception measurements following CNFL and CNBD stratification (P = .001 and < .001, respectively).
CCM might be a non-invasive method for detecting DSPN and its severity degree in Chinese patients diagnosed with type 2 diabetes.
评估角膜共聚焦显微镜（CCM）作为一种非侵入性测试，用于评估中国 2 型糖尿病患者的糖尿病周围神经病变。
根据改良的多伦多诊断标准，对 128 例 2 型糖尿病患者（无糖尿病周围神经病变 [n=49]、轻度糖尿病周围神经病变 [n=43]、中重度糖尿病周围神经病变 [n=36]）和 24 名年龄匹配的对照者进行糖尿病远端对称性多发性神经病变（DSPN）及其严重程度的评估。所有纳入的受试者均进行 CCM 检查。利用 Fiji 图像分析软件分析角膜神经纤维长度（CNFL）、角膜神经分支密度（CNBD）和角膜神经纤维密度（CNFD）。确定 CCM 作为一种非侵入性测试评估糖尿病周围神经病变的功效。
健康对照组、无、轻度和中重度 DPN 的 2 型糖尿病患者的 CNFL 分别为 17.99±0.66、15.82±0.64、14.98±0.63 和 12.49±0.93。与健康对照组相比，无、轻度和中重度 DSPN 的 2 型糖尿病患者的 CNFL 显著降低（P=0.012、0.003 和<0.001）。中重度 DSPN 患者的 CNFL 明显短于无或轻度 DSPN 患者（P<0.001 和 0.004）。健康对照组、无、轻度和中重度 DPN 的 2 型糖尿病患者的 CNBD 分别为 41.48±3.35、33.02±2.50、30.91±2.33 和 18.00±2.33。与无、轻度和中重度 DSPN 的 2 型糖尿病患者相比，健康对照组的 CNBD 明显更高（P=0.036、0.016 和<0.001）。中重度 DSPN 患者的 CNBD 明显低于无或轻度 DSPN 患者（均<0.001）。健康对照组、无、轻度和中重度 DPN 的 2 型糖尿病患者的 CNFD 分别为 35.32±1.18、35.68±1.10、34.54±1.12 和 32.28±1.76。4 组间 CNFD 无差异。在将 CNFL、CNFD 和 CNBD 分为四等份的分析中，4 组间肌电图检查和振动感觉阈值无显著差异；然而，在 CNFL 和 CNBD 分层后，温度感觉测量的阳性分布有显著差异（P=0.001 和<0.001）。
CCM 可能是一种非侵入性方法，用于检测中国 2 型糖尿病患者的 DSPN 及其严重程度。
