Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1) Heidelberg University Hospital, Heidelberg, Germany.
Front Endocrinol (Lausanne). 2022 May 10;13:839774. doi: 10.3389/fendo.2022.839774. eCollection 2022.
The pathogenesis of diabetic polyneuropathy (DN) is poorly understood and given the increasing prevalence of DN, there is a need for clinical or imaging biomarkers that quantify structural and functional nerve damage. While clinical studies have found evidence of an association between elevated levels of troponin T (hsTNT) and N-terminal pro brain natriuretic peptide (proBNP) with microvascular compromise in type 2 diabetes (T2D), their implication in mirroring DN nerve perfusion changes remains unclear. The objective of this study was, therefore, to investigate whether hsTNT and proBNP assays are associated with MRI nerve perfusion in T2D.
In this prospective cross-sectional single-center case-control study, 56 participants (44 with T2D, 12 healthy control subjects) consented to undergo magnetic resonance neurography (MRN) including dynamic contrast-enhanced (DCE) perfusion imaging of the right leg. Using the extended Tofts model, primary outcome parameters that were quantified are the sciatic nerve's microvascular permeability (K), the extravascular extracellular volume fraction (v), and the plasma volume fraction (v), as well as hsTNT and proBNP values from serological workup. Further secondary outcomes were clinical, serological, and electrophysiological findings.
In T2D patients, hsTNT was negatively correlated with K (r=-0.38; p=0.012) and v (r=-0.30; p=0.048) but not with v (r=-0.16; p=0.294). HsTNT, K, and v were correlated with peroneal nerve conduction velocities (NCVs; r=-0.44; p=0.006, r=0.42; p=0.008, r=0.39; p=0.014), and tibial NCVs (r=-0.38;p=0.022, r=0.33; p=0.048, r=0.37; p=0.025). No such correlations were found for proBNP.
This study is the first to find that hsTNT is correlated with a decrease of microvascular permeability and a reduced extravascular extracellular volume fraction of nerves in patients with T2D. The results indicate that hsTNT may serve as a potential marker for the assessment of nerve perfusion in future studies on DN.
糖尿病性多发性神经病（DN）的发病机制尚不清楚，鉴于 DN 的患病率不断上升，因此需要能够量化结构和功能神经损伤的临床或影像学生物标志物。虽然临床研究已经发现肌钙蛋白 T（hsTNT）和 N 末端脑利钠肽前体（proBNP）水平升高与 2 型糖尿病（T2D）微血管损伤之间存在关联，但它们在反映 DN 神经灌注变化方面的意义尚不清楚。因此，本研究旨在探讨 hsTNT 和 proBNP 检测与 T2D 患者 MRI 神经灌注之间是否存在关联。
在这项前瞻性横断面单中心病例对照研究中，56 名参与者（44 名 T2D 患者，12 名健康对照者）同意接受磁共振神经成像（MRN）检查，包括右腿动态对比增强（DCE）灌注成像。使用扩展的 Tofts 模型，量化的主要结果参数是坐骨神经的微血管通透性（K）、血管外细胞外容积分数（v）和血浆容积分数（v），以及血清学检查中的 hsTNT 和 proBNP 值。进一步的次要结果是临床、血清学和电生理学发现。
在 T2D 患者中，hsTNT 与 K（r=-0.38；p=0.012）和 v（r=-0.30；p=0.048）呈负相关，但与 v 不相关（r=-0.16；p=0.294）。hsTNT、K 和 v 与腓总神经传导速度（NCVs；r=-0.44；p=0.006，r=-0.42；p=0.008，r=-0.39；p=0.014）和胫神经 NCVs 相关（r=-0.38；p=0.022，r=-0.33；p=0.048，r=-0.37；p=0.025）。proBNP 则无此相关性。
本研究首次发现 hsTNT 与 T2D 患者神经微血管通透性降低和细胞外间隙体积分数降低相关。这些结果表明，hsTNT 可能作为未来 DN 神经灌注评估研究中的一个潜在标志物。
