Department of Endocrinology, Senior Resident, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Endocr Pract. 2023 Sep;29(9):692-698. doi: 10.1016/j.eprac.2023.06.004. Epub 2023 Jun 19.
Utility of corneal confocal microscopy (CCM) in children and adolescents with type 1 diabetes mellitus (T1DM) without neuropathic symptoms or signs and minimal abnormality in large and small nerve fiber function tests remains largely undetermined. This study aimed to evaluate the performance of CCM in comparison to thermal detection thresholds (TDT) testing and nerve conduction studies (NCS) for detecting neuropathy in children with T1DM.
A cohort of children and adolescents with T1DM (n = 51) and healthy controls (n = 50) underwent evaluation for symptoms and signs of neurological deficits, including warm detection threshold, cold detection threshold, vibration perception threshold, NCS, and CCM.
Children with T1DM had no or very minimal neuropathic symptoms and deficits based on the Toronto Clinical Neuropathy Score, yet NCS abnormalities were present in 18 (35%), small fiber dysfunction defined by an abnormal TDT was found in 13 (25.5%) and CCM abnormalities were present in 25 (49%). CCM was abnormal in a majority of T1DM children with abnormal TDT (12/13, 92%) and abnormal NCS (16/18, 88%). CCM additionally was able to detect small fiber abnormalities in 13/38 (34%) in T1DM with a normal TDT and in 9/33 (27%) with normal NCS.
CCM was able to detect corneal nerve loss in children with and without abnormalities in TDT and NCS.
在没有神经病变症状或体征且大、小纤维神经功能测试仅有微小异常的 1 型糖尿病（T1DM）儿童和青少年中，角膜共焦显微镜（CCM）的效用仍未得到充分确定。本研究旨在评估 CCM 与热探测阈值（TDT）测试和神经传导研究（NCS）相比，在检测 T1DM 儿童神经病变方面的性能。
一组患有 T1DM（n=51）和健康对照（n=50）的儿童和青少年接受了神经系统缺陷症状和体征的评估，包括温暖探测阈值、寒冷探测阈值、振动感知阈值、NCS 和 CCM。
T1DM 患儿无或仅有非常轻微的神经病变症状和缺陷，根据多伦多临床神经病变评分，但存在 NCS 异常（18 例，35%）、异常 TDT 定义的小纤维功能障碍（13 例，25.5%）和 CCM 异常（25 例，49%）。在异常 TDT（12/13，92%）和异常 NCS（16/18，88%）的大多数 T1DM 患儿中，CCM 异常。CCM 还能够在 TDT 正常（13/38，34%）和 NCS 正常（9/33，27%）的 T1DM 患儿中检测到小纤维异常。
CCM 能够检测出 TDT 和 NCS 异常和无异常的儿童的角膜神经损失。
