Alam Uazman, Ponirakis Georgios, Asghar Omar, Petropoulos Ioannis N, Azmi Shazli, Jeziorska Maria, Marshall Andrew, Boulton Andrew J M, Efron Nathan, Malik Rayaz A
Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester M13 9PL, UK.
Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK.
J Clin Med. 2022 Apr 18;11(8):2249. doi: 10.3390/jcm11082249.
There is a need to accurately identify patients with diabetes at higher risk of developing and progressing diabetic peripheral neuropathy (DPN). Fifty subjects with Type 1 Diabetes Mellitus (T1DM) and sixteen age matched healthy controls underwent detailed neuropathy assessments including symptoms, signs, quantitative sensory testing (QST), nerve conduction studies (NCS), intra epidermal nerve fiber density (IENFD) and corneal confocal microscopy (CCM) at baseline and after 2 years of follow-up. Overall, people with type 1 diabetes mellitus showed no significant change in HbA1c, blood pressure, lipids or neuropathic symptoms, signs, QST, neurophysiology, IENFD and CCM over 2 years. However, a sub-group ( = 11, 22%) referred to as progressors, demonstrated rapid corneal nerve fiber loss (RCNFL) with a reduction in corneal nerve fiber density (CNFD) ( = 0.0006), branch density (CNBD) ( = 0.0002), fiber length (CNFL) ( = 0.0002) and sural ( = 0.04) and peroneal ( = 0.05) nerve conduction velocities, which was not related to a change in HbA1c or cardiovascular risk factors. The majority of people with T1DM and good risk factor control do not show worsening of neuropathy over 2 years. However, CCM identifies a sub-group of people with T1DM who show a more rapid decline in corneal nerve fibers and nerve conduction velocity.
有必要准确识别出患糖尿病性周围神经病变（DPN）风险更高且病情会发展和进展的糖尿病患者。五十名1型糖尿病（T1DM）患者和十六名年龄匹配的健康对照者在基线期及随访2年后接受了详细的神经病变评估，包括症状、体征、定量感觉测试（QST）、神经传导研究（NCS）、表皮内神经纤维密度（IENFD）和角膜共焦显微镜检查（CCM）。总体而言，1型糖尿病患者在2年期间的糖化血红蛋白、血压、血脂或神经病变症状、体征、QST、神经生理学、IENFD和CCM均无显著变化。然而，一个被称为病情进展者的亚组（n = 11，22%）出现了快速角膜神经纤维丢失（RCNFL），角膜神经纤维密度（CNFD）降低（P = 0.0006）、分支密度（CNBD）降低（P = 0.0002）、纤维长度（CNFL）降低（P = 0.0002），腓肠神经（P = 0.04）和腓总神经（P = 0.05）的神经传导速度降低，这与糖化血红蛋白或心血管危险因素的变化无关。大多数T1DM患者且危险因素控制良好者在2年期间神经病变并未恶化。然而，CCM识别出了一组T1DM患者，他们的角膜神经纤维和神经传导速度下降更快。
