Ferdousi Maryam, Kalteniece Alise, Azmi Shazli, Petropoulos Ioannis N, Worthington Anne, D'Onofrio Luca, Dhage Shaishav, Ponirakis Georgios, Alam Uazman, Marshall Andrew, Faber Catharina G, Lauria Giuseppe, Soran Handrean, Malik Rayaz A
Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Research Division, Weill Cornell Medical College in Qatar, Doha, Qatar.
BMJ Open Diabetes Res Care. 2020 Dec;8(2). doi: 10.1136/bmjdrc-2020-001801.
Diabetic neuropathy can be diagnosed and assessed using a number of techniques including corneal confocal microscopy (CCM).
We have undertaken quantitative sensory testing, nerve conduction studies and CCM in 143 patients with type 1 and type 2 diabetes without neuropathy (n=51), mild neuropathy (n=47) and moderate to severe neuropathy (n=45) and age-matched controls (n=30).
Vibration perception threshold (p<0.0001), warm perception threshold (WPT) (p<0.001), sural nerve conduction velocity (SNCV) (p<0.001), corneal nerve fiber density (CNFD) (p<0.0001), corneal nerve branch density (CNBD) (p<0.0001), corneal nerve fiber length (CNFL) (p=0.002), inferior whorl length (IWL) (p=0.0001) and average nerve fiber length (ANFL) (p=0.0001) showed a progressive abnormality with increasing severity of diabetic neuropathy. Receiver operating characteristic curve analysis for the diagnosis of diabetic neuropathy showed comparable performance in relation to the area under the curve (AUC) but differing sensitivities and specificities for vibration perception threshold (AUC 0.79, sensitivity 55%, specificity 90%), WPT (AUC 0.67, sensitivity 50%, specificity 76%), cold perception threshold (AUC 0.64, sensitivity 80%, specificity 47%), SNCV (AUC 0.70, sensitivity 76%, specificity 54%), CNFD (AUC 0.71, sensitivity 58%, specificity 83%), CNBD (AUC 0.70, sensitivity 69%, specificity 65%), CNFL (AUC 0.68, sensitivity 64%, specificity 67%), IWL (AUC 0.72, sensitivity 70%, specificity 65%) and ANFL (AUC 0.72, sensitivity 71%, specificity 66%).
This study shows that CCM identifies early and progressive corneal nerve loss at the inferior whorl and central cornea and has comparable utility with quantitative sensory testing and nerve conduction in the diagnosis of diabetic neuropathy.
糖尿病性神经病变可通过多种技术进行诊断和评估，包括角膜共焦显微镜检查（CCM）。
我们对143例1型和2型糖尿病患者进行了定量感觉测试、神经传导研究和CCM检查，这些患者无神经病变（n = 51）、轻度神经病变（n = 47）、中度至重度神经病变（n = 45），并设有年龄匹配的对照组（n = 30）。
振动觉阈值（p<0.0001）、温觉阈值（WPT）（p<0.001）、腓肠神经传导速度（SNCV）（p<0.001）、角膜神经纤维密度（CNFD）（p<0.0001）、角膜神经分支密度（CNBD）（p<0.0001）、角膜神经纤维长度（CNFL）（p = 0.002）、下象限长度（IWL）（p = 0.0001）和平均神经纤维长度（ANFL）（p = 0.0001）随着糖尿病性神经病变严重程度的增加呈现出逐渐加重的异常。糖尿病性神经病变诊断的受试者工作特征曲线分析显示，各指标在曲线下面积（AUC）方面表现相当，但在振动觉阈值（AUC 0.79，灵敏度55%，特异度90%）、WPT（AUC 0.67，灵敏度50%，特异度76%）、冷觉阈值（AUC 0.64，灵敏度80%，特异度47%）、SNCV（AUC 0.70，灵敏度76%，特异度54%）、CNFD（AUC 0.71，灵敏度58%，特异度83%）、CNBD（AUC 0.70，灵敏度69%，特异度65%）、CNFL（AUC 0.68，灵敏度64%，特异度67%）、IWL（AUC 0.72，灵敏度70%，特异度65%）和ANFL（AUC 0.72，灵敏度71%，特异度66%）方面的灵敏度和特异度有所不同。
本研究表明，CCM可识别下象限和中央角膜早期及进行性角膜神经纤维丢失，在糖尿病性神经病变的诊断中与定量感觉测试和神经传导检查具有相当的效用。
