Corneal confocal microscopy detects early nerve regeneration after pancreas transplantation in patients with type 1 diabetes
Corneal confocal microscopy detects early nerve regeneration after pancreas transplantation in patients with type 1 diabetes
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DOI：
10.2337/dc07-0870
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发表时间：
2007-10-01
期刊：
影响因子：
16.2
通讯作者：
Malik, Rayaz A.
中科院分区：
文献类型：
--
作者：
Mehra, Sanjay;Tavakoli, Mitra;Malik, Rayaz A.
目的-角膜共聚焦显微镜（CCM）是一种快速，无创，临床检查技术，量化小神经纤维病理。我们已经用它来评估胰腺移植在I型糖尿病patients.RESEARCH设计和方法神经系统的好处-在20例I型糖尿病患者接受胰肾联合移植（SPK）和15名对照组，角膜敏感性进行了评价，使用非接触式角膜感觉，和小神经纤维形态学进行了评估，使用CCM。（1.54 +/- 0.28 vs. 0.77 +/- 0.02，P < 0.0001），神经纤维密度（NFD）（13.8 +/- 2. 1对比42 +/- 3.2，P < 0. 000 1）、神经分支密度（NBD）（4.04 +/- 1.5 vs. 26.7 +/- 2.5，P < 0.0001）和神经纤维长度（NFL）（2.23 +/- 0.2 vs. 9.69 +/- 0.7，P < 0.0001）显著降低，神经纤维迂曲度（NFT）（15.7 ± 1.02 vs. 19.56 ± 1.34，P = 0.04）在胰腺移植前糖尿病患者中增加。SPK术后6个月，15名患者接受了第二次评估，显示NFD有显著改善（18.04 +/- 10.48 vs. 9.25 +/- 1.87，P = 0.001）和NFL（3.60 +/- 0.33 vs. 1.84 +/- 0.33，P = 0.002），NBD无变化（1.38 +/- 0.74 vs. 1.38 +/- 1.00，P = 1.0），NFT（15.58 +/- 1.20 vs. 16.30 +/- 1.19，P = 0.67）或角膜敏感性（1.23 +/-0.39vs.1.54 +/- 00.42，P = 0.59）.结论-尽管接受胰腺移植的I型糖尿病患者有明显的神经纤维损伤，使用CCM可以在胰腺移植的6个月内检测到小纤维修复。CCM是一种新型的无创临床技术，用于评估人类糖尿病神经病变治疗干预的益处。
OBJECTIVE - Corneal confocal microscopy (CCM) is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber pathology. We have used it to assess the neurological benefits of pancreas transplantation in type I diabetic patients.RESEARCH DESIGN AND METHODS - In 20 patients with type I diabetes undergoing simultaneous pancreas and kidney transplantation (SPK) and 15 control subjects, corneal sensitivity was evaluated using noncontact corneal esthesiometry, and small nerve fiber morphology was assessed using CCM.RESULTS - Corneal sensitivity (1.54 +/- 0.28 vs. 0.77 +/- 0.02, P < 0.0001), nerve fiber density (NFD) (13.8 +/- 2. 1 vs. 42 +/- 3.2, P < 0. 000 1), nerve branch density (NBD) (4.04 +/- 1.5 vs. 26.7 +/- 2.5, P < 0.0001), and nerve fiber length (NFL) (2.23 +/- 0.2 vs. 9.69 +/- 0.7, P < 0.0001) were significantly reduced, and nerve fiber tortuosity (NFT) (15.7 +/- 1.02 vs. 19.56 +/- 1.34, P = 0.04) was increased in diabetic patients before pancreas transplantation. Six months after SPK, 15 patients underwent a second assessment and showed a significant improvement in NFD (18.04 +/- 10.48 vs. 9.25 +/- 1.87, P = 0.001) and NFL (3.60 +/- 0.33 vs. 1.84 +/- 0.33, P = 0.002) with no change in NBD (1.38 +/- 0.74 vs. 1.38 +/- 1.00, P = 1.0), NFT (15.58 +/- 1.20 vs. 16.30 +/- 1.19, P = 0.67), or corneal sensitivity (1.23 +/- 0.39 vs. 1.54 +/- 00.42, P = 0.59).CONCLUSIONS - Despite marked nerve fiber damage in type I diabetic patients undergoing pancreas transplantation, small fiber repair can be detected within 6 months of pancreas transplantation using CCM. CCM is a novel noninvasive clinical technique to assess the benefits of therapeutic intervention in human diabetic neuropathy.