Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Diabetes Res Clin Pract. 2023 Jul;201:110736. doi: 10.1016/j.diabres.2023.110736. Epub 2023 Jun 3.
To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy.
Sixty adolescents with type 1 diabetes (diabetes duration > five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis.
The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75).
The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.
使用成人已知的确认性试验，评估 1 型糖尿病青少年的大纤维（LFN）、小纤维（SFN）和自主神经病变的患病率，并确定神经病变的危险因素和床旁方法。
60 名患有 1 型糖尿病（糖尿病病程> 5 年）的青少年和 23 名对照者接受了神经学检查和神经病变的确认性诊断性检查，包括神经传导研究、测定表皮内神经纤维密度的皮肤活检、定量自主神经反射测试（QSART）、心血管反射测试（CART）和倾斜台试验。分析了可能的危险因素。使用 ROC 分析比较了床旁检查（生物感觉测定、DPNCheck®、Sudoscan 和 Vagus®设备）与确认性检查。
糖尿病青少年（平均 HbA1c 7.6%（60mmol/mol））的神经病变患病率如下：14%确诊/26%亚临床 LFN、2%确诊/25%亚临床 SFN、20%异常 QSART、8%异常 CART 和 14%直立性低血压。发现年龄较大、胰岛素剂量较高、既往吸烟和甘油三酯水平较高会增加神经病变的相对风险。这些床旁检查与确认性检查的一致性较差或可接受（所有 AUC 值均≤0.75）。
诊断性试验证实了糖尿病青少年存在神经病变，并强调了预防和筛查的重要性。
