角膜共焦显微镜对小纤维神经病的早期诊断价值

The value of corneal confocal microscopy in diagnosing early small fibre neuropathy

目的 评价角膜共焦显微镜对小纤维神经病的早期诊断价值.方法 选择45例小纤维神经病患者和50例年龄及性别匹配的健康人群作为健康对照组.采用角膜共焦显微镜观察并量化分析角膜上皮下神经纤维的角膜神经纤维长度（NFL）、神经分支密度（NBD）、神经纤维密度（NFD）、神经纤维弯曲度（NFT）;同时进行神经残疾量表评分、接触性热痛诱发电位、腓肠神经传导速度等检查.结果 小纤维神经病组的NFD、NBD均小于健康对照组[（42.00±25.26）个/mm2比（72.38±14.09）个/mm2;（31.93±13.21）个/mm2比（46.24±11.48）个/mm2],NFT显著大于健康对照组[（2.48±0.87）级比（0.88±0.56）级],差异均有统计学意义（P均＜0.05）.神经残疾量表评分与NFT、NFD、NBD相关（r=0.782、-0.376、-0.504,P均＜0.001）.结论 角膜共焦显微镜作为一种无创、新型的检测手段,对于小纤维神经病的早期诊断有重要价值.

Objective To explore the diagnostic value of corneal confocal microscopy in the early small fibre neuropathy （SFN）.Methods A total of 45 patients with small fibre neuropathy and 50 age-matched healthy subjects undertook a neurological evaluation,neurological deficits score （NDS）,sural nerve conduction velocity,contact heat evoked potential （CHEP） and corneal confocal microscopy （CCM） to quantify small nerve fibre pathology.Four parameters including nerve fiber length （NFL）,nerve branch density （NBD）,nerve fiber density （NFD） and nerve fibre tortuosity （NFT） were calculated from the observation of corneal confocal microscopy.Results Compared with the control group,significantly decreased NFD and NBD were found in the SFN group [（42.00 ±25.26）/mm2 vs （72.38 ± 14.09） /mm2 ;（31.93 ± 13.21）/mm2 vs （46.24 ± 11.48）/mm2 ; with all P 〈 0.05],while NFT were significantly increased in the SFN group [（2.48 ±0.87） levels vs （0.88 ±0.56） levels,P 〈0.001].The neurological deficits score was correlated with NFT,NFD and NBD （r =0.782,-0.376,-0.504 ; with all P 〈 0.001）.Conclusion CCM is a new and sensitive noninvasive clinical technique that may be used to detect early small fibre nerve damage in patients with SFN.