Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy
Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy
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DOI：
10.1002/acn3.275
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发表时间：
2016-02-01
影响因子：
5.3
通讯作者：
Kieseier, Bernd C.
中科院分区：
文献类型：
--
作者：
Stettner, Mark;Hinrichs, Lena;Kieseier, Bernd C.
有一个未满足的需求，更好的诊断工具，以进一步描绘临床亚型的异质性慢性炎症性脱髓鞘性多神经根神经病（CIDP）和多灶性运动神经病（MMN），以促进治疗决策。角膜共聚焦显微镜（CCM）是一种非侵入性和可重复的神经成像技术。本研究评估了CCM作为CIDP和MMN的诊断替代物的潜力。MethodsIn a cross-sectional prospective approach，182例患者和健康对照进行了研究，使用CCM量化角膜神经损伤和免疫细胞infiltration.ResultsPatients与CIDP和MMN有减少角膜神经纤维（CNF）的措施和增加角膜免疫细胞infiltration. ResultsPatients。在CIDP中，CNF参数随着病程的增加而降低。CNFs附近的树突状细胞数量在早期疾病患者中增加，并与运动影响的程度相关。在疼痛性神经病变患者中观察到CNF参数进一步降低和非树突状细胞增加。在CIDP患者与抗神经元抗体的nondendritic cells的数量increased.InterpretationOur研究结果表明，CNF损失可能反映神经病变的严重程度和定量周围的CNF丛不同的细胞可能有助于分层CIDP亚型，临床过程中，和疾病活动。然而，在CCM被视为CIDP和MMN患者的有效替代终点之前，需要进行进一步的纵向研究。
ObjectiveThere is an unmet need for better diagnostic tools to further delineate clinical subsets of heterogeneous chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) to facilitate treatment decisions. Corneal confocal microscopy (CCM) is a noninvasive and reproducible nerve imaging technique. This study evaluates the potential of CCM as a diagnostic surrogate in CIDP and MMN.MethodsIn a cross-sectional prospective approach, 182 patients and healthy controls were studied using CCM to quantify corneal nerve damage and immune cell infiltration.ResultsPatients with CIDP and MMN had a reduction in corneal nerve fiber (CNF) measures and an increase in corneal immune cell infiltrates. In CIDP, CNF parameters decreased with increasing duration of disease. The number of dendritic cells in proximity to CNFs was increased in patients with early disease and correlated with the degree of motor affection. A further reduction in CNF parameters and an increase in nondendritic cells were observed in patients with painful neuropathy. In CIDP patients with antineuronal antibodies the number of nondendritic cells was increased.InterpretationOur findings suggest that CNF loss may reflect severity of neuropathy and quantification of distinct cells around the CNF plexus may help in stratifying CIDP subtypes, clinical course, and disease activity. However, further longitudinal studies are required before CCM can be considered as a valid surrogate endpoint for patients with CIDP and MMN.