Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation.
Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation.
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作者：
Tavakoli M;Mitu-Pretorian M;Petropoulos IN;Fadavi H;Asghar O;Alam U;Ponirakis G;Jeziorska M;Marshall A;Efron N;Boulton AJ;Augustine T;Malik RA
糖尿病性神经病变与发病率和死亡率增加有关。迄今为止，糖耐量受损和糖尿病患者的有限数据显示干预后神经纤维修复。这可能反映了干预措施的有效性不足，但也可能反映了目前用于充分评估神经纤维修复的测试的难度，特别是在短期研究中。角膜共聚焦显微镜（CCM）代表了一种新的无创手段来量化神经纤维损伤和修复。15例接受同步胰肾移植（SPK）的1型糖尿病患者在基线和SPK成功后6个月和12个月对神经功能缺损、定量感觉测试（QST）、电生理、皮肤活检、角膜敏感性和CCM进行了详细评估。在基线时，与对照组相比，糖尿病患者有明显的神经病变。SPK成功后，神经功能损伤、神经生理学、QST、角膜敏感性和表皮内神经纤维密度（IENFD）均无显著变化。然而，在12个月时，CCM在角膜神经纤维密度、分支密度和长度方面有显著改善。通过神经功能缺损、QST、电生理和IENFD评估，SPK后血糖正常化显示神经病变无明显改善。然而，CCM在神经形态学上显示出显著的改善，提供了一种新的无创手段来建立早期神经修复，这是目前提倡的评估技术所错过的。
Diabetic neuropathy is associated with increased morbidity and mortality. To date, limited data in subjects with impaired glucose tolerance and diabetes demonstrate nerve fiber repair after intervention. This may reflect a lack of efficacy of the interventions but may also reflect difficulty of the tests currently deployed to adequately assess nerve fiber repair, particularly in short-term studies. Corneal confocal microscopy (CCM) represents a novel noninvasive means to quantify nerve fiber damage and repair. Fifteen type 1 diabetic patients undergoing simultaneous pancreas–kidney transplantation (SPK) underwent detailed assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal sensitivity, and CCM at baseline and at 6 and 12 months after successful SPK. At baseline, diabetic patients had a significant neuropathy compared with control subjects. After successful SPK there was no significant change in neurologic impairment, neurophysiology, QST, corneal sensitivity, and intraepidermal nerve fiber density (IENFD). However, CCM demonstrated significant improvements in corneal nerve fiber density, branch density, and length at 12 months. Normalization of glycemia after SPK shows no significant improvement in neuropathy assessed by the neurologic deficits, QST, electrophysiology, and IENFD. However, CCM shows a significant improvement in nerve morphology, providing a novel noninvasive means to establish early nerve repair that is missed by currently advocated assessment techniques.
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影响因子：
16.2
作者：
Mehra, Sanjay;Tavakoli, Mitra;Malik, Rayaz A.
通讯作者：
Malik, Rayaz A.
影响因子：
16.2
作者：
Albers JW;Herman WH;Pop-Busui R;Feldman EL;Martin CL;Cleary PA;Waberski BH;Lachin JM;Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications Research Group
通讯作者：
Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications Research Group
影响因子：
8.2
作者：
Malik, RA;Tesfaye, S;Ward, JD
通讯作者：
Ward, JD
影响因子：
16.2
作者：
Fiorina, Paolo;Perseghin, Gianluca;Del Maschio, Alessandro
通讯作者：
Del Maschio, Alessandro
影响因子：
8
作者：
Malik, R. A.;Veves, A.;Lauria, G.
通讯作者：
Lauria, G.