Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany.
Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße 140, 18057 Rostock, Germany.
J Diabetes Res. 2018 Nov 4;2018:5910639. doi: 10.1155/2018/5910639. eCollection 2018.
Diabetic neuroosteoarthropathy (DNOAP) early symptoms are unspecific, mimicking general infectious symptoms and rendering a diagnosis challenging. Consequently, unfavourable outcomes occur frequently, with recurrent foot ulceration, infectious complications, and eventually amputation. Corneal confocal microscopy (CCM) of the subbasal nerve plexus (SNP) is used to detect early peripheral neuropathy in diabetic patients without diabetic retinopathy. This pilot study was designed to determine if specific SNP changes manifest in severe DNOAP in comparison to a healthy control group.
This pilot study utilized a matched-pair analysis to investigate SNP changes by in vivo CCM for 26 patients (mean patient age 63.7 years, range 27 to 78) with severe DNOAP defined by condition after the need for reconstructive foot surgery ( = 13) and a healthy control group ( = 13). Corneal nerve fibre length (CNFL), nerve fibre density (CNFD), nerve branch density (CNBD), average weighted corneal nerve fibre thickness (CNFTh), nerve connecting points (CNCP), and average weighted corneal nerve fibre tortuosity (CNFTo) were assessed as well as the general clinical status, diabetic status, and ophthalmologic basic criteria.
In vivo CCM revealed significantly reduced SNP parameters in the DNOAP group for CNFL ( = 0.010), CNFD ( = 0.037), CNBD ( = 0.049), and CNCP ( = 0.012) when compared to the healthy control group. Six patients (46%) of the DNOAP group suffered from diabetic retinopathy and none of the control group.
This pilot study revealed a rarefication of SNP in all measured parameters in patients with severe DNOAP. We see a potential value of CCM providing a SNP-based biomarker for early stages of DNOAP prior to the development of any foot deformities that needs to be evaluated in further studies. This trial is registered with German Clinical Trials Register (DKRS) DRKS00007537.
糖尿病神经骨关节病（DNOAP）的早期症状不特异，类似于一般感染症状，导致诊断具有挑战性。因此，经常出现不良结局，包括足部溃疡复发、感染并发症，最终导致截肢。角膜共聚焦显微镜（CCM）可用于检测无糖尿病视网膜病变的糖尿病患者的早期周围神经病变。本初步研究旨在确定与健康对照组相比，严重 DNOAP 中是否存在特定的 SNP 变化。
本初步研究采用配对分析，通过活体 CCM 检测 26 例（平均患者年龄 63.7 岁，范围 27-78 岁）严重 DNOAP 患者（因需要重建足部手术而确诊 13 例）和健康对照组（13 例）的 SNP 变化。评估角膜神经纤维长度（CNFL）、神经纤维密度（CNFD）、神经分支密度（CNBD）、平均加权角膜神经纤维厚度（CNFTh）、神经连接点（CNCP）和平均加权角膜神经纤维扭曲度（CNFTo），以及一般临床状况、糖尿病状况和眼科基本标准。
活体 CCM 显示，与健康对照组相比，DNOAP 组的 SNP 参数 CNFL（ = 0.010）、CNFD（ = 0.037）、CNBD（ = 0.049）和 CNCP（ = 0.012）明显降低。DNOAP 组有 6 名患者（46%）患有糖尿病视网膜病变，而对照组没有。
本初步研究显示，严重 DNOAP 患者的 SNP 出现了所有测量参数的稀疏。我们认为 CCM 具有提供 DNOAP 早期阶段基于 SNP 的生物标志物的潜力，而无需足部畸形发展，这需要在进一步的研究中进行评估。该试验在德国临床试验注册中心（DRKS）注册，DRKS00007537。
