Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.
Division of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
Eur J Neurol. 2021 May;28(5):1745-1751. doi: 10.1111/ene.14757. Epub 2021 Feb 23.
Damage to small nociceptive fibres may contribute to painful diabetic neuropathy. We aimed to compare large and small nerve fibre measurements together with skin biopsy and corneal confocal microscopy in patients with type 1 diabetes and painful or painless diabetic neuropathy.
We have assessed the McGill pain questionnaire, neuropathy disability score, vibration perception threshold, warm and cold sensation thresholds, electrophysiology, corneal confocal microscopy and skin biopsy in participants with type 1 diabetes and painful (n = 41) or painless (n = 50) diabetic neuropathy and control subjects (n = 50).
The duration of diabetes, body mass index, glycated haemoglobin (HbA1c), blood pressure and lipid profile did not differ between subjects with painful and painless neuropathy. Neuropathy disability score and vibration perception threshold were higher and sural nerve conduction velocity was lower, but sural nerve amplitude, peroneal nerve amplitude and conduction velocity and cold and warm sensation thresholds did not differ between patients with painful compared to painless diabetic neuropathy. However, intraepidermal nerve fibre density, corneal nerve fibre density, corneal nerve branch density and corneal nerve fibre length were significantly lower in subjects with painful compared to painless diabetic neuropathy.
There is evidence of more severe neuropathy, particularly small fibre damage in the skin and cornea, of patients with painful compared to painless diabetic neuropathy.
小伤害性纤维的损伤可能与痛性糖尿病周围神经病变有关。我们旨在比较 1 型糖尿病伴痛性或无痛性糖尿病周围神经病变患者的大、小神经纤维测量值，以及皮肤活检和角膜共聚焦显微镜检查。
我们评估了麦吉尔疼痛问卷、周围神经病变残疾评分、振动感觉阈值、温觉和冷觉阈值、电生理学、角膜共聚焦显微镜和皮肤活检，纳入了 41 例痛性和 50 例无痛性糖尿病周围神经病变患者以及 50 例对照受试者。
痛性和无痛性神经病变患者的糖尿病病程、体重指数、糖化血红蛋白（HbA1c）、血压和血脂谱无差异。与无痛性糖尿病周围神经病变相比，神经病变残疾评分和振动感觉阈值较高，而腓肠神经传导速度较低，但腓肠神经振幅、腓总神经振幅和传导速度以及冷觉和温觉阈值无差异。然而，与无痛性糖尿病周围神经病变相比，痛性糖尿病周围神经病变患者的表皮内神经纤维密度、角膜神经纤维密度、角膜神经分支密度和角膜神经纤维长度显著降低。
与无痛性糖尿病周围神经病变相比，痛性糖尿病周围神经病变患者的神经病变更严重，尤其是皮肤和角膜的小纤维损伤。
