Utility of corneal confocal microscopy for assessing mild diabetic neuropathy: baseline findings of the LANDMark study
Utility of corneal confocal microscopy for assessing mild diabetic neuropathy: baseline findings of the LANDMark study
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DOI：
10.1111/j.1444-0938.2012.00740.x
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发表时间：
2012-05-01
影响因子：
1.9
通讯作者：
Efron, Nathan
中科院分区：
文献类型：
--
作者：
Edwards, Katie;Pritchard, Nicola;Efron, Nathan
背景：对于糖尿病并发症管理领域的人们来说，糖尿病周围神经病变（DPN）的准确诊断和监测仍然是一个挑战。角膜基底神经形态的评估最近显示出作为检测 DPN 的新型眼科标记物的前景。方法：231 名主要患有轻度或无神经病变的糖尿病患者和 61 名对照者接受了糖尿病神经病变症状评分、神经病变残疾评分、10 克单丝测试、定量感觉测试（热、冷、振动检测）和神经传导研究的评估。使用角膜共聚焦显微镜测量角膜神经纤维长度、分支密度和弯曲度。使用方差分析研究患有和不患有 DPN 的个体与对照之间角膜神经形态的差异，并确定角膜形态与已建立的 DPN 测试和危险因素之间的相关性。结果：与对照组 (p < 0.001) 和无 DPN 的糖尿病患者 (p = 0.012) 相比，患有轻度 DPN 的糖尿病患者的角膜神经纤维长度显着缩短。与对照组相比，轻度 DPN 患者的角膜神经分支密度显着降低 (p = 0.032)。角膜神经纤维弯曲度没有表现出显着差异。角膜神经纤维长度和角膜神经分支密度与大多数神经病变指标显示出适度的相关性，与神经传导研究参数的相关性最强（r = 0.15 至 0.25）。角膜神经纤维弯曲度与振动检测阈值仅有微弱的相关性。角膜神经纤维长度与糖化血红蛋白（r = -0.24）和糖尿病病程（r = -0.20）呈负相关。结论：角膜神经形态评估是一种无创、快速的测试，能够显示患有和不患有 DPN 的个体之间的差异。角膜神经纤维长度与其他神经病诊断测试以及已确定的神经病危险因素的相关性最强。
Background: For those in the field of managing diabetic complications, the accurate diagnosis and monitoring of diabetic peripheral neuropathy (DPN) continues to be a challenge. Assessment of sub-basal corneal nerve morphology has recently shown promise as a novel ophthalmic marker for the detection of DPN. Methods: Two hundred and thirty-one individuals with diabetes with predominantly mild or no neuropathy and 61 controls underwent evaluation of diabetic neuropathy symptom score, neuropathy disability score, testing with 10-g monofilament, quantitative sensory testing (warm, cold, vibration detection) and nerve conduction studies. Corneal nerve fibre length, branch density and tortuosity were measured using corneal confocal microscopy. Differences in corneal nerve morphology between individuals with and without DPN and controls were investigated using analysis of variance and correlations were determined between corneal morphology and established tests of, and risk factors for, DPN. Results: Corneal nerve fibre length was significantly reduced in diabetic individuals with mild DPN compared with both controls (p < 0.001) and diabetic individuals without DPN (p = 0.012). Corneal nerve branch density was significantly reduced in individuals with mild DPN compared with controls (p = 0.032). Corneal nerve fibre tortuosity did not show significant differences. Corneal nerve fibre length and corneal nerve branch density showed modest correlations to most measures of neuropathy, with the strongest correlations to nerve conduction study parameters (r = 0.15 to 0.25). Corneal nerve fibre tortuosity showed only a weak correlation to the vibration detection threshold. Corneal nerve fibre length was inversely correlated to glycated haemoglobin (r = -0.24) and duration of diabetes (r = -0.20). Conclusion: Assessment of corneal nerve morphology is a non-invasive, rapid test capable of showing differences between individuals with and without DPN. Corneal nerve fibre length shows the strongest associations with other diagnostic tests of neuropathy and with established risk factors for neuropathy.