Zhao Qian, Wang Jialin, Liu Fangfang, Jiang Hongwei, Ma Yujin
Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
Luoyang Key Laboratory of Clinical Multiomics and Translational Medicine, Henan Key Laboratory of Rare Diseases, Luoyang, China.
Front Endocrinol (Lausanne). 2025 Mar 31;16:1496635. doi: 10.3389/fendo.2025.1496635. eCollection 2025.
This study investigates nerve fiber dysfunction in type 1 diabetes (T1D) patients and identifies risk factors for diabetic peripheral neuropathy (DPN). It evaluates the relationship between current perception threshold (CPT) tests and nerve conduction velocity (NCV), and assesses CPT's diagnostic accuracy for early DPN detection.
This study enrolled 110 patients with T1D and 26 healthy controls between January 2020 and December 2021, in accordance with predefined inclusion/exclusion criteria. CPT testing at 2000 Hz, 250 Hz, and 5 Hz assessed Aβ, Aδ, and C fiber function, while NCV was measured in 47 patients. Subgroups were stratified by disease duration (>5 years vs ≤5 years). Multivariate logistic regression identified DPN risk factors, and CPT-NCV correlation was analyzed using Chi-square and Kappa tests. Receiver operating characteristic (ROC) curves evaluated CPT diagnostic efficacy.
The incidence of DPN in 110 T1D patients was 78%, with no significant difference between disease duration subgroups (78.3% vs. 78.0%). Neurological abnormalities were significantly more common in the lower extremities compared to the upper extremities (67.27% vs. 49.09%, < 0.05). Multivariate logistic regression analysis revealed that a waist-to-hip ratio (WHR) greater than 0.85 was an independent risk factor for DPN ( = 3.01, 95% : 1.03-8.80, < 0.05). Patients with a disease duration >5 years demonstrated significantly higher 2000Hz abnormality rates (68.09% vs. 46.15%, < 0.05) and more severe neurological lesions (57.45% vs. 35.90%, < 0.05). In contrast, those with disease duration ≤5 years exhibited elevated 5Hz abnormality rates (30.77% vs. 10.64%, < 0.05) with predominantly milder lesions (56.41% vs. 31.91%, < 0.05). Statistical analyses demonstrated a significant association between CPT and NCV (<0.001), with moderate diagnostic consistency further supported by Cohen's Kappa Test (κ=0.515, <0.001). ROC curve analysis demonstrated that CPT exhibited moderate diagnostic accuracy in detecting DPN at the 5Hz, with an area under the curve (AUC) of 0.723.
CPT showed moderate diagnostic accuracy for early unmyelinated (C) fibers detection, routine CPT screening in high-risk groups (central obesity/short disease duration) enables timely intervention to prevent irreversible damage.
本研究调查1型糖尿病（T1D）患者的神经纤维功能障碍，并确定糖尿病周围神经病变（DPN）的危险因素。评估电流感觉阈值（CPT）测试与神经传导速度（NCV）之间的关系，并评估CPT对早期DPN检测的诊断准确性。
本研究根据预先定义的纳入/排除标准，于2020年1月至2021年12月招募了110例T1D患者和26名健康对照者。在2000Hz、250Hz和5Hz频率下进行CPT测试，以评估Aβ、Aδ和C纤维功能，同时对47例患者测量NCV。根据病程（>5年与≤5年）进行亚组分层。多因素逻辑回归分析确定DPN的危险因素，并使用卡方检验和Kappa检验分析CPT与NCV的相关性。采用受试者工作特征（ROC）曲线评估CPT的诊断效能。
110例T1D患者中DPN的发生率为78%，病程亚组之间无显著差异（78.3%对78.0%）。与上肢相比，下肢神经异常明显更常见（67.27%对49.09%，P<0.05）。多因素逻辑回归分析显示，腰臀比（WHR）大于0.85是DPN的独立危险因素（β=3.01，95%CI：1.03-8.80，P<0.05）。病程>5年的患者2000Hz异常率显著更高（68.09%对46.15%，P<0.05），神经病变更严重（57.45%对35.90%，P<0.0)。相比之下，病程≤5年的患者5Hz异常率升高（30.77%对10.64%，P<0.05），主要为较轻病变（56.41%对31.91%，P<0.05）。统计分析表明CPT与NCV之间存在显著关联（P<0.001），Cohen's Kappa检验进一步支持了中度诊断一致性（κ=0.515，P<0.001）。ROC曲线分析表明，CPT在5Hz检测DPN时具有中度诊断准确性，曲线下面积（AUC）为0.723。
CPT对早期无髓鞘（C）纤维检测显示出中度诊断准确性，在高危人群（中心性肥胖/病程短）中进行常规CPT筛查可及时进行干预，以防止不可逆转的损伤。
