Natural History of Corneal Nerve Morphology in Mild Neuropathy Associated With Type 1 Diabetes: Development of a Potential Measure of Diabetic Peripheral Neuropathy
Natural History of Corneal Nerve Morphology in Mild Neuropathy Associated With Type 1 Diabetes: Development of a Potential Measure of Diabetic Peripheral Neuropathy
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DOI：
10.1167/iovs.14-15605
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发表时间：
2014-12-01
影响因子：
4.4
通讯作者：
Efron, Nathan
中科院分区：
文献类型：
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作者：
Dehghani, Cirous;Pritchard, Nicola;Efron, Nathan
目的.探讨糖尿病患者基底下神经丛（subbasalnerveplexus，SNP）形态的纵向变化及其与神经病变常规指标的关系。一组147名1型糖尿病患者和60名年龄均衡的对照者在基线和随后的四次年度访视时对临床和代谢因素、神经功能缺损、定量感觉测试、神经传导研究和角膜共焦显微镜进行了详细评估。SNP参数包括角膜神经纤维密度（CNFD）、分支密度（CNBD）和纤维长度（CNFL），并使用全自动算法进行定量。线性混合模型拟合检查角膜神经参数随时间的变化。基线时，27%的参与者有轻度糖尿病神经病变。神经病变组各SNP参数均显著低于对照组（P < 0.05）。总体而言，89%的基线检查参与者也完成了最终访视。从基线至最终访视，健康和代谢参数以及神经病变测量值无临床显著变化。线性混合模型显示，与对照组相比，神经病变组CNFD呈显著线性下降（年变化率，-0.9神经/mm（2），P = 0.01），这与年龄（β =-0.06，P = 0.04）和糖尿病病程（β =-0.08，P = 0.03）相关。神经病组CNBD和CNFL的绝对变化与腓神经传导速度和冷觉阈值呈中度相关（r分别为0.38和0.40，P < 0.05）。这项研究表明，在SNP的动态小纤维损伤，从而为我们正在进行的努力，以建立角膜神经形态作为一个适当的辅助糖尿病周围神经病变的常规措施提供了理由。
PURPOSE. To investigate longitudinal changes of subbasal nerve plexus (SNP) morphology and its relationship with conventional measures of neuropathy in individuals with diabetes.METHODS. A cohort of 147 individuals with type 1 diabetes and 60 age-balanced controls underwent detailed assessment of clinical and metabolic factors, neurologic deficits, quantitative sensory testing, nerve conduction studies, and corneal confocal microscopy at baseline and four subsequent annual visits. The SNP parameters included corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL), and were quantified using a fully automated algorithm. Linear mixed models were fitted to examine the changes in corneal nerve parameters over time.RESULTS. At baseline, 27% of the participants had mild diabetic neuropathy. All SNP parameters were significantly lower in the neuropathy group compared with controls (P < 0.05). Overall, 89% of participants examined at baseline also completed the final visit. There was no clinically significant change to health and metabolic parameters and neuropathy measures from baseline to the final visit. Linear mixed model revealed a significant linear decline of CNFD (annual change rate, -0.9 nerve/mm(2), P = 0.01) in the neuropathy group compared with controls, which was associated with age (beta = -0.06, P = 0.04) and duration of diabetes (beta = -0.08, P = 0.03). In the neuropathy group, absolute changes of CNBD and CNFL showed moderate correlations with peroneal conduction velocity and cold sensation threshold, respectively (r, 0.38 and 0.40, P < 0.05).CONCLUSIONS. This study demonstrates dynamic small fiber damage at the SNP, thus providing justification for our ongoing efforts to establish corneal nerve morphology as an appropriate adjunct to conventional measures of diabetic peripheral neuropathy.