2 型糖尿病患者角膜共焦显微镜与周围神经结构和功能标志物的关系。

Relationship between corneal confocal microscopy and markers of peripheral nerve structure and function in Type 2 diabetes.

机构信息

Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.

School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.

出版信息

Diabet Med. 2020 Feb;37(2):326-334. doi: 10.1111/dme.13952. Epub 2019 Apr 6.

DOI:10.1111/dme.13952

PMID:30897245

Abstract

AIMS

To investigate changes in corneal nerve morphology in Type 2 diabetes and to establish relationships between in vivo corneal confocal microscopy and markers of peripheral nerve structure and function.

PARTICIPANTS AND METHODS

We recruited 57 participants with Type 2 diabetes and 26 healthy controls of similar age and sex distribution. We also recruited a disease control group of 54 participants with Type 1 diabetes. All participants were assessed for distal symmetrical polyneuropathy using the Total Neuropathy Score. In vivo corneal confocal microscopy was used to assess corneal nerve fibre length, corneal nerve fibre density, corneal nerve branch density and inferior whorl length. Peripheral nerve structure was assessed using median nerve ultrasonography. Large fibre function was assessed according to median nerve axonal excitability. Small fibre function was assessed using Sudoscan and the Survey of Autonomic Symptoms.

RESULTS

Corneal nerve fibre length, fibre density and branch density and inferior whorl length were significantly lower in individuals with Type 2 diabetes compared to controls (P<0.001 for all). In the Type 2 diabetes cohort, correlations were observed between neuropathy severity and corneal nerve fibre density (P=0.004), corneal nerve branch density (P=0.003), corneal nerve fibre length (P=0.002) and inferior whorl length (P=0.01). Significant correlations were observed between corneal confocal outcomes and axonal excitability measurements. No association was found between corneal confocal microscopy and median nerve cross-sectional area, Sudoscan measurements or the Survey of Autonomic Symptoms.

CONCLUSIONS

This study demonstrated significant changes in corneal nerves in individuals with Type 2 diabetes. Reductions in corneal nerve measures correlated with increasing neuropathy severity. Associations were found between corneal confocal microscopy and markers of voltage-gated potassium channel function.

摘要

目的

研究 2 型糖尿病患者角膜神经形态的变化，并建立活体角膜共聚焦显微镜与周围神经结构和功能标志物之间的关系。

参与者和方法

我们招募了 57 名 2 型糖尿病患者和 26 名年龄和性别分布相似的健康对照者。我们还招募了 54 名 1 型糖尿病患者作为疾病对照组。所有参与者均采用总神经病变评分（Total Neuropathy Score）评估远端对称性多发性神经病。采用活体角膜共聚焦显微镜评估角膜神经纤维长度、角膜神经纤维密度、角膜神经分支密度和下涡长度。采用正中神经超声评估周围神经结构。根据正中神经轴突兴奋性评估大纤维功能。采用 Sudoscan 和自主症状调查评估小纤维功能。

结果

与对照组相比，2 型糖尿病患者的角膜神经纤维长度、纤维密度和分支密度以及下涡长度明显降低（所有 P<0.001）。在 2 型糖尿病队列中，神经病变严重程度与角膜神经纤维密度（P=0.004）、角膜神经分支密度（P=0.003）、角膜神经纤维长度（P=0.002）和下涡长度（P=0.01）呈相关性。角膜共聚焦结果与轴突兴奋性测量值之间存在显著相关性。然而，角膜共聚焦显微镜与正中神经横截面积、Sudoscan 测量值或自主症状调查之间没有关联。