Ma Jun, Zhang Junfang, Tan Mengjia, Ji Min, Yu Jianfeng, Guan Huaijin
Department of Ophthalmology, Medical School of Nantong University, The Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Department of Ophthalmology, Yancheng First People's Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, Jiangsu, China.
J Diabetes Res. 2025 Apr 12;2025:4586856. doi: 10.1155/jdr/4586856. eCollection 2025.
Although prediabetes increases the risk of developing diabetes, its role in neuropathy remains unclear. We aim to assess alterations in the corneal nerve structure and function in prediabetes and risk factors for corneal nerve loss. An examination of IVCM and corneal sensitivity was conducted on a cohort of 75 participants, comprising 23 controls, 32 prediabetes, and 20 Type 2 diabetes. Semiautomatic analysis was employed to quantify the corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), and dendritic cell (DC) density. CNFL and CNFD were lower in prediabetes and Type 2 diabetes than in the controls, and they were associated with DC density. CNFL and CNFD were lower in Type 2 diabetes than in prediabetes. DC density was higher in prediabetes and Type 2 diabetes than in controls. However, there were no differences in corneal sensitivity between controls and prediabetes. Multivariable regression analysis demonstrated an association between reduced CNFL and age, BMI, fasting plasma glucose (FPG), and uric acid (UA) levels in prediabetes. In Type 2 diabetes, age, HbA1c, blood urea nitrogen (BUN), creatinine (Cr), and triglyceride levels exhibited associations with reduced CNFL. Corneal nerve damage was detected in prediabetes using IVCM. The patients with prediabetes showed signs of nerve structure damage, and the corneal nerve structure damage occurred before the nerve function changes. Immune cells also participate in the occurrence and development of DCN and are related to the corneal neuropathy. Understanding the corneal nerve fiber condition through IVCM may prove crucial in monitoring prediabetic neuropathy.
尽管糖尿病前期会增加患糖尿病的风险，但其在神经病变中的作用仍不明确。我们旨在评估糖尿病前期角膜神经结构和功能的改变以及角膜神经损伤的危险因素。对75名参与者进行了共聚焦显微镜（IVCM）检查和角膜敏感性检测，其中包括23名对照组、32名糖尿病前期患者和20名2型糖尿病患者。采用半自动分析方法对角膜神经纤维长度（CNFL）、角膜神经纤维密度（CNFD）和树突状细胞（DC）密度进行量化。糖尿病前期和2型糖尿病患者的CNFL和CNFD均低于对照组，且与DC密度相关。2型糖尿病患者的CNFL和CNFD低于糖尿病前期患者。糖尿病前期和2型糖尿病患者的DC密度高于对照组。然而，对照组和糖尿病前期患者之间的角膜敏感性没有差异。多变量回归分析表明，糖尿病前期患者CNFL降低与年龄、体重指数（BMI）、空腹血糖（FPG）和尿酸（UA）水平有关。在2型糖尿病中，年龄、糖化血红蛋白（HbA1c）、血尿素氮（BUN）、肌酐（Cr）和甘油三酯水平与CNFL降低有关。使用IVCM在糖尿病前期检测到角膜神经损伤。糖尿病前期患者出现神经结构损伤迹象，且角膜神经结构损伤发生在神经功能改变之前。免疫细胞也参与糖尿病性角膜神经病变（DCN）的发生和发展，并与角膜神经病变有关。通过IVCM了解角膜神经纤维状况可能对监测糖尿病前期神经病变至关重要。
