Small fibre neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy
Small fibre neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy
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DOI：
10.1002/dmrr.1222
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发表时间：
2011-10-01
影响因子：
8
通讯作者：
Lauria, G.
中科院分区：
文献类型：
--
作者：
Malik, R. A.;Veves, A.;Lauria, G.
小纤维占外周神经纤维的70-90%，并调节几个关键功能，如组织血流，温度和疼痛感知以及出汗，所有这些都与糖尿病患者足部溃疡相关的临床表现和不良结局高度相关。最近的研究表明，尽管电生理学正常，但糖耐量受损和糖尿病受试者的小纤维存在显著异常，这表明最早的神经纤维损伤是小纤维。不幸的是，指南和共识声明侧重于大纤维，并继续倡导电生理学作为一种诊断方式，并作为评估治疗益处的主要终点。(In部分，这反映了量化小纤维功能障碍和损伤的困难。因此，我们严格评估了目前可用的技术，测量小纤维功能障碍的糖尿病神经病变，使用定量感觉和出汗测试。我们已经评估了通过定量皮肤活检表皮内神经纤维密度和使用角膜共聚焦显微镜的角膜神经形态来识别结构损伤的作用。最后，我们提出了一个糖尿病神经病变的定义，包括小纤维损伤。版权所有（C）2011 John Wiley & Sons，
Small fibres constitute 70-90% of peripheral nerve fibres and regulate several key functions such as tissue blood flow, temperature and pain perception as well as sweating, all of which are highly relevant to the clinical presentation and adverse outcomes associated with foot ulcerations in patients with diabetes. Recent studies demonstrated significant abnormalities in the small fibres in subjects with impaired glucose tolerance and diabetes, despite normal electrophysiology, suggesting that the earliest nerve fibre damage is to the small fibres. Unfortunately, guidelines and consensus statements focus on large fibres and continue to advocate electrophysiology as a diagnostic modality and as a primary end point for the assessment of therapeutic benefit. (In part, this reflects the difficulties in quantifying small fibre dysfunction and damage.) We have therefore critically assessed currently available techniques that measure small fibre dysfunction in diabetic neuropathy, using quantitative sensory and sudomotor testing. We have assessed the role of identifying structural damage by quantifying intraepidermal nerve fibre density in skin biopsies and corneal nerve morphology using corneal confocal microscopy. Finally, we propose a definition for diabetic neuropathy that incorporates small fibre damage. Copyright (C) 2011 John Wiley & Sons,