Che N N, Ding G X, Chen S Y, Li D S, Li X, Ma J J, Yang H Q
Department of Neurology, Henan University People's Hospital, Zhengzhou 450003, China.
Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Yi Xue Za Zhi. 2021 Feb 23;101(7):498-503. doi: 10.3760/cma.j.cn112137-20200614-01851.
To analyze the characteristic changes of corneal nerve fibers in patients with Parkinson's disease (PD) by corneal confocal microscopy (CCM) and investigate the association of corneal nerve fiber parameters with disease severity and motor symptoms. Forty-two patients with PD were recruited from the Department of Neurology, Henan University People's Hospital from June 2018 to October 2019. Meanwhile, 40 healthy controls who visited the hospital for physical examination at the same period were enrolled. Corneal nerve fibers in both eyes of all participants were detected by using CCM. The differences of corneal nerve fibers were comparatively analyzed between PD group and healthy controls. Associations of corneal nerve parameters with clinical characteristics such as course of disease, Hoehn and Yahr stage (H-Y stage), unified Parkinson disease rating scale (UPDRS), levodopa equivalent daily dosage (LEDD) were analyzed by using partial correlations. The receiver operating characteristic (ROC) curve was used to analyze the capability of corneal nerve fibers for distinguishing patients with PD from healthy controls. Corneal nerve fiber density (CNFD) in PD group ((19±3)/mm) was significantly decreased compared with healthy controls ((28±4)/mm) (=10.798, 0.001). However, corneal nerve branch density (CNBD) was significantly increased in PD group ((25±11)/mm) compared with healthy controls ((18±6)/mm) (=-3.427, =0.001). Meanwhile, corneal nerve fiber length (CNFL) was decreased in PD group ((11.0±2.5) mm/mm) in comparison with healthy controls ((12.5±1.6) mm/mm) (=3.139, =0.002). ROC curve analysis revealed that CNFD could discriminate PD patients from healthy controls, with an area under the curve of 0.961 3 (95%: 92.42-99.84, <0.000 1). CNFD was negatively correlated with H-Y stage and UPDRS-Ⅲ (=-0.501 and -0.399, both 0.05). CNBD was significantly negatively associated with H-Y stage, UPDRS-Ⅲ and UPDRS-Total (=-0.622, -0.394 and -0.354, respectively, all 0.05). CNFL was negatively correlated with H-Y stage, UPDRS-Ⅲ and UPDRS-total (=-0.574, -0.484 and -0.422, respectively, all 0.05). Small nerve fiber injuries exist in PD patients. Corneal nerve fibers negatively correlates with motor symptoms. CNFD have a good discriminative power to distinguish PD patients from healthy controls and may serve as a marker for PD.
通过角膜共焦显微镜（CCM）分析帕金森病（PD）患者角膜神经纤维的特征性变化，并探讨角膜神经纤维参数与疾病严重程度和运动症状之间的关联。2018年6月至2019年10月，从河南大学人民医院神经内科招募了42例PD患者。同时，纳入了同期来院进行体检的40名健康对照者。使用CCM检测所有参与者双眼的角膜神经纤维。比较分析PD组和健康对照组之间角膜神经纤维的差异。采用偏相关分析角膜神经参数与病程、 Hoehn和Yahr分期（H-Y分期）、统一帕金森病评定量表（UPDRS）、左旋多巴等效日剂量（LEDD）等临床特征的相关性。采用受试者工作特征（ROC）曲线分析角膜神经纤维区分PD患者和健康对照者的能力。PD组角膜神经纤维密度（CNFD）为（19±3）/mm，显著低于健康对照组（（28±4）/mm）（=10.798，P<0.001）。然而，PD组角膜神经分支密度（CNBD）为（25±11）/mm，显著高于健康对照组（（18±6）/mm）（=-3.427，P=0.001）。同时，PD组角膜神经纤维长度（CNFL）为（11.0±2.5）mm/mm，低于健康对照组（（12.5±1.6）mm/mm）（=3.139，P=0.002）。ROC曲线分析显示，CNFD能够区分PD患者和健康对照者，曲线下面积为0.961 3（95%置信区间：92.42-99.84，P<0.000 1）。CNFD与H-Y分期和UPDRS-Ⅲ呈负相关（分别为=-0.501和-0.399，均P<0.05）。CNBD与H-Y分期、UPDRS-Ⅲ和UPDRS总分均呈显著负相关（分别为=-0.622、-0.394和-0.354，均P<0.05）。CNFL与H-Y分期、UPDRS-Ⅲ和UPDRS总分呈负相关（分别为=-0.574、-0.484和-0.422，均P<0.05）。PD患者存在小神经纤维损伤。角膜神经纤维与运动症状呈负相关。CNFD对区分PD患者和健康对照者具有良好的鉴别能力，可能作为PD的一个标志物。
