Li Qiang, Liu XiaoXiao, Jia Mengxiao, Sun Fang, Li Yingsha, Zhang Hexuan, Liu Xiaoli, He Hongbo, Zhao Zhigang, Yan Zhencheng, Zhu Zhiming
Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Diabetol Metab Syndr. 2022 Jul 6;14(1):90. doi: 10.1186/s13098-022-00864-3.
To investigate the potential of employing sublingual microcirculation as an early noninvasive screening technique for diabetic nephropathy (DN).
We recruited 89 patients with type 2 diabetes mellitus (T2DM) and 41 healthy subjects in this cross-sectional observational study. All participants underwent fluorescein fundus angiography, vibration perception testing, 10 g (Semmes-Weinstein) monofilament examination, nerve conduction velocity, and 24-h urine microalbumin determination. HbA1c, fasting plasma glucose, blood lipid, and estimated glomerular filtration rate(eGFR) were measured. Sublingual microcirculatory images were captured using side-stream dark-field (SDF) microcirculation microscopy, and total and perfused vascular density (TVD and PVD) were calculated.
The sublingual microcirculatory parameters denoting microvascular density and perfusion were negatively correlated with both fasting plasma glucose (TVD, r = - 0.316, P < 0.001; PVD, r = - 0.350, P < 0.001; PPV, r = - 0.279, P = 0.001) and HbA1c (TVD, r = - 0.367, P < 0.001; PVD, r = - 0.423, P < 0.001; PPV, r = - 0.399, P < 0.001). Diabetes patients already had a reduction in sublingual microcirculation compared with healthy control, and more severe reductions in TVD (7.07 ± 1.64 vs. 9.67 ± 1.94 mm/mm, P < 0.001) and PVD (5.88 ± 1.82 vs. 8.64 ± 2.46 mm/mm, P < 0.001) were found in those diabetes patients developed microvascular complications. Sublingual microcirculation impairment was accompanied with higher urinary albumin creatinine ratio (UACR). Receiver operating characteristic (ROC) analysis showed that TVD (area under the curve, AUC = 0.890 [0.836 0.944], P < 0.001) and PVD (AUC = 0.883 [0.826, 0.940], P < 0.001) could be indicators for DN screening. We derived a combined predictor index (CPI) considering both TVD and PVD for screening DN, and both the AUC (0.892, [0.838 0.945], P < 0.001) and cutoff point of 11.30 mm/mm showed great improvement (sensitivity: 95.5%, specificity: 67.4%).
Diabetes patients experienced impaired sublingual microcirculation, which was closely correlated with UACR. Sublingual microcirculation monitoring could be used for the noninvasive early detection of DN.
探讨将舌下微循环作为糖尿病肾病（DN）早期无创筛查技术的潜力。
在这项横断面观察性研究中，我们招募了89例2型糖尿病（T2DM）患者和41名健康受试者。所有参与者均接受了荧光素眼底血管造影、振动觉测试、10g（Semmes-Weinstein）单丝检查、神经传导速度测定以及24小时尿微量白蛋白测定。测量了糖化血红蛋白（HbA1c）、空腹血糖、血脂和估计肾小球滤过率（eGFR）。使用侧流暗场（SDF）微循环显微镜采集舌下微循环图像，并计算总血管密度和灌注血管密度（TVD和PVD）。
表示微血管密度和灌注的舌下微循环参数与空腹血糖（TVD，r = -0.316，P < 0.001；PVD，r = -0.350，P < 0.001；PPV，r = -0.279，P = 0.001）和HbA1c（TVD，r = -0.367，P < 0.001；PVD；r = -0.423，P < 0.001；PPV，r = -0.399，P < 0.001）均呈负相关。与健康对照相比，糖尿病患者的舌下微循环已经降低，并且在发生微血管并发症的糖尿病患者中发现TVD（7.07±1.64 vs. 9.67±1.94mm/mm，P < 0.001）和PVD（5.88±1.82 vs. 8.64±2.46mm/mm，P < 0.001）有更严重的降低。舌下微循环障碍与较高的尿白蛋白肌酐比值（UACR）相关。受试者工作特征（ROC）分析表明，TVD（曲线下面积AUC = 0.890 [0.836, 0.944]，P < 0.001）和PVD（AUC = 0.883 [0.826, 0.940]，P < 0.001）可作为DN筛查指标。我们推导了一个综合预测指标（CPI），同时考虑TVD和PVD用于筛查DN，AUC（0.892，[0.838, 0.9, 45]，P < 0.001）和截断点11.30mm/mm均显示出显著改善（敏感性：95.5%，特异性：67.4%）。
糖尿病患者存在舌下微循环受损，这与UACR密切相关。舌下微循环监测可用于DN的无创早期检测。
