2型糖尿病患者角膜神经形态与糖尿病微血管并发症关系研究

Relationship between corneal nerve morphology and microvascular complications in type 2 diabetic patients

目的评价糖尿病患者角膜神经形态变化与糖尿病视网膜病变及糖尿病肾病的关系。方法纳入95例2型糖尿病患者及30例健康志愿者(对照组)进行角膜共聚焦显微镜检查,以评价角膜神经形态改变。糖尿病患者进行微血管并发症检查,分为糖尿病周围神经病变组(DPN)及无糖尿病周围神经病变组(NDPN);糖尿病视网膜病变组(DR)及无糖尿病视网膜病变组(NDR);糖尿病肾病组(DN)及无糖尿病肾病组(NDN)。结果角膜神经纤维密度(CNFD)、角膜神经分支密度(CNBD)、角膜神经纤维长度(CNFL)等在NDPN组、NDR组、NDN组较健康对照组显著降低(P<0.001),DPN组、DR组、DN组较NDPN组、NDR组、NDN组进一步降低(P<0.001)。CNFD、CNBD、CNFL与腓总神经运动神经传导速度(PMNCV)、腓肠神经感觉神经传导速度(SSNCV)及腓肠神经波幅(SSmv)显著相关(P<0.01)。结论角膜神经改变可早期诊断糖尿病周围神经病变,在未发生糖尿病视网膜病变或糖尿病肾病的患者中即可检出角膜神经病变。

Objective To evaluate the relationship between changes in corneal nerve morphology and diabetic retinopathy and nephropathy. Methods 95 cases of diabetic patients and 30 cases of healthy subjects underwent corneal confocal microscopy and changes in their corneal nerve morphology were evaluated. Diabetic patients underwent assessment of diabetic microvascular and three types of group-division： they were first divided into diabetic neuropathy（DPN） group and non-diabetic neuropathy group, then into diabetic retinopathy（DR） group and non-diabeticretinopathy（NDR） group, and finally into diabetic nephropathy（DN）group and non-diabeticnephropathy（NDN） group. Results Corneal nerve fiber density（CNFD）, corneal nerve branch density（CNBD）and corneal nerve fiber length（CNFL） decreased significantly for subjects in NDPN, NDR, NDN groups compared with those in healthy control group（P〈0.001）; further decrease were observed in DPN, DR and DN groups compared with NDPN, NDR, NDN groups（P〈0.001）. CNFD, CNBD, CNFL were significantly correlated with peroneal motor nerve conduction velocity（PMNCV）, suralsensory nerve conduction velocity（SSNCV） and the amplitude of suralnerve（SSmv）（P〈0.01）. Conclusion Changes of corneal nerve morphology can help with early diagnosis of diabetic peripheral neuropathy. Damages of corneal nerve morphology precedes diabetic retinopathy and diabetic nephropathy in type 2 diabetes.