Universidade Federal Fluminense, Facultdade de Medicina, Departamento de Medicina Clínica, Serviço de Neurologia, Niterói RJ, Brasil.
Arq Neuropsiquiatr. 2022 Aug;80(8):812-821. doi: 10.1055/s-0042-1755231. Epub 2022 Oct 17.
Diabetic neuropathy (DN) is a very common clinical condition throughout the world. The diagnostic tests currently recommended have low sensitivity, such as electromyography, or are invasive, such as skin biopsy. New techniques have been developed to identify the early involvement of the peripheral nerve. With the advent of corneal confocal microscopy (CCM), a reduction in corneal innervation in patients with DN has been observed.
To compare, through CCM, diabetic patients with symptomatic distal symmetric polyneuropathy (DSP) and controls.
In the present study, through CCM, we compared the morphological changes in the sub-basal epithelial corneal plexus of 35 diabetic patients with symptomatic DSP with 55 controls. Moreover, we sought to determine a pattern of change regarding the severity stages of DSP, comparing the clinical, laboratory, and nerve-conduction (NC) variables.
Differences between the control and diabetic groups were observed for the following variables, respectively: age (44.9 ± 13.24 years versus 57.02 ± 10.4 years; < 0.001); fiber density (29.7 ± 10.2 versus 16.6 ± 10.2; < 0.001); number of fibers (4.76 ± 1.30 versus 3.14 ± 1.63; < 0.001); number of Langerhans cells (4.64 ± 8.05 versus 7.49 ± 10.3; = 0.035); tortuosity ( < 0.05); and thickness ( < 0.05). Furthermore, inverse relationships were found regarding fiber density and age ( < 0.01) and fiber density and the severity of the disease ( < 0.05). A positive relationship between the conduction velocity of the fibular nerve and fiber density ( < 0.05) was also observed.
Corneal confocal microscopy proved to be a fast, noninvasive and reproducible method for the diagnosis, staging, and monitoring of diabetic DSP.
糖尿病性神经病（DN）是一种在全世界都很常见的临床病症。目前推荐的诊断测试，例如肌电图，敏感性较低，或者例如皮肤活检，具有侵入性。已经开发出新技术来识别外周神经的早期受累情况。随着角膜共焦显微镜（CCM）的出现，已经观察到 DN 患者的角膜神经支配减少。
通过 CCM 比较有症状的远端对称性多发性神经病（DSP）的糖尿病患者和对照组。
在本研究中，我们通过 CCM 比较了 35 例有症状的 DSP 糖尿病患者和 55 例对照组的亚基底上皮角膜丛的形态变化。此外，我们试图通过比较 DSP 的严重程度阶段的临床、实验室和神经传导（NC）变量，确定一种变化模式。
对照组和糖尿病组之间的差异观察到以下变量：年龄（44.9±13.24 岁与 57.02±10.4 岁； <0.001）；纤维密度（29.7±10.2 与 16.6±10.2； <0.001）；纤维数量（4.76±1.30 与 3.14±1.63； <0.001）；朗格汉斯细胞数量（4.64±8.05 与 7.49±10.3； = 0.035）；扭曲度（ <0.05）；和厚度（ <0.05）。此外，纤维密度与年龄（ <0.01）和纤维密度与疾病严重程度（ <0.05）之间存在反比关系。还观察到腓肠神经传导速度与纤维密度之间存在正相关（ <0.05）。
角膜共焦显微镜被证明是一种快速、非侵入性和可重复的方法，可用于诊断、分期和监测糖尿病 DSP。
