角膜共聚焦显微镜在糖尿病周围神经病变的早期评估和监测中的应用及价值

Application and value of corneal confocal microscopy in early evaluation and monitoring of diabetic peripheral neuropathy

人体角膜具有丰富的神经支配,负责角膜营养和稳态的维持。糖尿病患者的角膜神经支配受损,且已广泛证明糖尿病性神经病可影响角膜基底神经丛,包括神经的形态、长度和密度,并且这些改变可能先于糖尿病神经病变的临床发作。角膜共聚焦显微镜(CCM)是一种快速的非侵入性、可重复、简单的眼科成像技术,可在细胞水平上研究角膜的不同层面,可以在体内评估糖尿病患者的角膜神经丧失,角膜神经丧失对糖尿病的躯体和自主神经病变具有良好的诊断价值,并可监测其发展,近期越来越多的研究使用角膜共聚焦显微镜检测糖尿病神经病变。本文总结了糖尿病患者角膜神经改变以及改变程度与疾病持续时间和严重程度之间的关系,分析角膜共聚焦显微镜用于糖尿病周围感觉运动性多发性神经病的早期评估及病情监测的相关证据。通过CCM从活体角膜基底神经丛研究中获得的有关角膜神经纤维状况的信息可能对早期发现糖尿病外周小纤维多发性神经病以及监测其发展至关重要。

Cornea is the most innervated organ of human body,which is responsible for the maintenance of corneal nutrition and homeostasis.Corneal innervation is impaired in diabetes,and it has been widely proved that diabetic neuropathy affects the corneal sub-basal nerve plexus,including corneal nerve fibers morphology,length and density.These changes seem to prior to the clinical onset of diabetic neuropathy.Corneal confocal microscopy(CCM)is a rapid,non-invasive,reproducible,and simple ophthalmic imaging technique that allows for the study of different layers of the cornea at a cellular level.It enables the in vivo assessment of corneal nerve loss in patients with diabetes.Corneal nerve loss has demonstrated excellent diagnostic value for somatic and autonomic diabetic neuropathy and can be used to monitor its progression.Recently,an increasing number of studies have utilized corneal confocal microscopy to detect diabetic neuropathy.This review summarized the corneal nerve alterations in patients with diabetes and the relationship between the extent of these changes and the duration and severity of diabetes.It also provided an overview of the relevant evidence regarding the utility of CCM in the early evaluation and monitoring of diabetic peripheral sensorimotor polyneuropathy.We believe that the information about the corneal nerve fibers obtained from the in vivo investigation of the sub-basal nerve plexus using CCM is crucial for the early detection and monitoring of diabetic peripheral neuropathy and its progression.