In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus
In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus
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DOI：
10.1007/s00417-010-1396-8
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发表时间：
2010-09-01
影响因子：
2.7
通讯作者：
Kampik, Anselm
中科院分区：
文献类型：
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作者：
Messmer, Elisabeth M.;Schmid-Tannwald, Christoph;Kampik, Anselm
晚期糖尿病角膜病变包括角膜感觉受损，泪液分泌减少，结膜鳞状化生，杯状细胞丢失，以及角膜糜烂和溃疡的易感性。它被认为是一种全身性糖尿病神经病变。早期诊断神经纤维变性是防止进一步损害的必要条件。我们用体内共聚焦显微镜检查了不同持续时间的1型和2型糖尿病患者的角膜神经支配模式，并将我们的发现与糖尿病视网膜病变、角膜感觉、下肢周围糖尿病神经病变和肾病的严重程度联系起来。非糖尿病视网膜病变患者的神经纤维长度（NFL）与对照组差异有统计学意义（p = 0.028）。非增生性糖尿病视网膜病变（NPDR）和增生性糖尿病视网膜病变（PDR）患者的神经纤维参数包括密度（NFD）、NFL、角膜神经分支（NB）与健康人相比差异越来越显著。肾病和/或周围神经病变史（均p < 0.001）、角膜感觉下降（均p < 0.01）和病理性振动感觉（均p < 0.01）与NFD、NFL和NB的减少（振动感觉除外）显著相关。出乎意料的是，与角膜和振动感觉完好的健康志愿者相比，角膜和振动感觉正常的糖尿病患者的NFD （p = 0.005）、NFL和NB （p均= 0.001）发生了显著变化。共聚焦显微镜是一种有价值的工具，显示细微的角膜神经改变在体内。它能够比角膜感觉测试和下肢振动感知评估更早地显示糖尿病神经纤维损伤。
Advanced diabetic keratopathy includes impaired corneal sensation, reduced tear secretion, conjunctival squamous metaplasia, and goblet cell loss, as well as susceptibility to corneal erosions and ulcerations. It is thought to be a form of generalized diabetic neuropathy. Early diagnosis of nerve fiber degeneration is essential to prevent further damage.We examined the corneal innervation pattern of patients with diabetes mellitus type 1 and 2 of various durations by in vivo confocal microscopy, and correlated our findings to the severity of diabetic retinopathy, corneal sensation, peripheral diabetic neuropathy in the lower limb, and nephropathy.Nerve fiber length (NFL) was significantly different between patients without diabetic retinopathy and controls (p = 0.028). In patients with non-proliferative diabetic retinopathy (NPDR) and patients with proliferative diabetic retinopathy (PDR), nerve fiber parameters including density (NFD), NFL, and corneal nerve branching (NB) showed a difference with increasing significance compared to healthy persons. A history of nephropathy and/or peripheral neuropathy (all p < 0.001), decreased corneal sensation (all p a parts per thousand currency signaEuro parts per thousand 0.03), and pathological vibration sensation (p a parts per thousand currency signaEuro parts per thousand 0.04) were significantly associated with a decrease in NFD, NFL, and NB (except vibration sensation). Unexpectedly, diabetic patients with normal corneal and vibration sensation demonstrated significant changes in NFD (p = 0.005), NFL, and NB (both p = 0.001) compared to healthy volunteers with intact corneal and vibration sensation.Confocal microscopy is a valuable tool for demonstrating subtle corneal nerve alterations in vivo. It is capable of demonstrating diabetic nerve fiber damage earlier than corneal sensation testing and vibration perception assessment in the lower limb.