Abnormal LDIflare but normal quantitative sensory testing and dermal nerve fiber density in patients with painful diabetic neuropathy.
Abnormal LDIflare but normal quantitative sensory testing and dermal nerve fiber density in patients with painful diabetic neuropathy.
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DOI：
10.2337/dc08-1453
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发表时间：
2009-03
期刊：
影响因子：
16.2
通讯作者：
Rayman, Gerry
中科院分区：
文献类型：
--
作者：
Krishnan, Singhan T. M.;Quattrini, Cristian;Jeziorska, Maria;Malik, Rayaz A.;Rayman, Gerry
目的--小神经纤维功能异常可能是糖尿病神经病变的早期特征，也可能是疼痛症状的基础。评估小纤维损伤的方法包括定量感觉测试（QST）和确定表皮内神经纤维密度。我们最近描述了一种可重复的生理技术，LDIflare，它评估小纤维功能，从而可能反映结构损伤前的早期功能障碍。通过与QST和真皮神经纤维密度（NFD）的比较，评估该技术在痛性神经病中的价值。研究设计和方法：15名健康对照者，10名2型糖尿病伴疼痛性神经病变（PFN）患者，12名2型糖尿病伴无痛性神经病变（PLN）患者。对足背进行LDIflare和QST，并确定皮肤NFD。与对照组相比，PLN患者的大小纤维定量感觉测试结果均异常，而PFN患者则无异常。与对照组受试者相比，PLN组的皮肤NFD也显著降低（205.8 ± 165.3 vs. 424.9 ± 176.3 [平均值± SD]; P = 0.003），但PFN组未降低（307.6 ± 164.5）。相比之下，与对照受试者（4.38 ± 1.4）相比，PFN（1.59 ± 0.41）和PLN（1.51 ± 0.56）组的LDIflare（平方厘米）均减少（P < 0.001）。NFD与LDIflare显著相关（r = 0.57，P < 0.0001）。结论：LDIflare显示PFN患者的小纤维功能受损，而其他评估未显示异常。我们认为，这种方法具有潜在的诊断价值，特别是因为它是非侵入性的，具有良好的重现性，并与NFD相关。此外，它可能在评估早期神经病变的预防性治疗中发挥重要作用。
OBJECTIVE—Abnormal small nerve fiber function may be an early feature of diabetic neuropathy and may also underlie painful symptoms. Methods for assessing small-fiber damage include quantitative sensory testing (QST) and determining intraepidermal nerve fiber density. We recently described a reproducible physiological technique, the LDIflare, which assesses small-fiber function and thus may reflect early dysfunction before structural damage. The value of this technique in painful neuropathy was assessed by comparing it with QST and dermal nerve fiber density (NFD). RESEARCH DESIGN AND METHODS—Fifteen healthy control subjects, 10 subjects with type 2 diabetes and painful neuropathy (PFN), and 12 subjects with type 2 diabetes and painless neuropathy (PLN) were studied. LDIflare and QST were performed on the dorsum of the foot, and dermal NFD was determined. RESULTS—Results of both large- and small-fiber quantitative sensory tests were abnormal in patients with PLN but not those with PFN compared with control subjects. Dermal NFD was also significantly reduced in the PLN group compared with control subjects (205.8 ± 165.3 vs. 424.9 ± 176.3 [mean ± SD]; P = 0.003) but not in the PFN group (307.6 ± 164.5). In contrast, the LDIflare (square centimeters) was reduced in both PFN (1.59 ± 0.41) and PLN (1.51 ± 0.56) groups compared with control subjects (4.38 ± 1.4) (P < 0.001 for both). NFD correlated significantly with the LDIflare (r = 0.57, P < 0.0001). CONCLUSIONS—The LDIflare demonstrated impaired small-fiber function in patients with PFN when other assessments revealed no abnormality. We believe that this method has potential diagnostic value, particularly because it is noninvasive, has excellent reproducibility, and correlates with NFD. Furthermore, it may have an important role in assessing preventative therapies in early neuropathy.
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