角膜神经纤维形态改变与糖尿病心脏自主神经病变的关系  

Relationship between morphological changes of corneal nerve fibers and diabetic cardiac autonomic neuropathy

作　　者：贾晓凡[1] 鲜彤章[1] 张丽娜[1] 王忆力[1] 王晓霞[1] 潘琦[1] 喻晓兵[1] 郭立新[1] Jia Xiaofan;Xian Tongzhang;Zhang Lina;Wang Yili;Wang Xiaoxia;Pan Qi;Yu Xiaobing;Guo Lixin(Department of Endocrinology,Beijing Hospital,National Center of Gerontology, Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心内分泌科,100730

出　　处：《中华糖尿病杂志》2019年第7期472-476,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(81670763、81471050).

摘　　要：目的探讨角膜神经纤维的形态改变与糖尿病心脏自主神经病变(DCAN)的关系,探索DCAN的早期诊断方法。方法2017年9月至2018年3月纳入62例住院糖尿病患者[男28例,女34例,平均年龄(57±13)岁]和20名健康受试者[男8例,女12例,平均年龄(52±8)岁]。所有受试者进行Ewing试验、24 h动态心电图、角膜共焦显微镜检查。根据心血管反射试验(Ewing试验)将糖尿病患者分为DCAN组(n=30)和非DCAN组(n=32),采用独立样本t检验、ANOVA方差分析等方法比较角膜神经参数在DCAN组、非DCAN组和正常对照组之间的差异,对角膜神经参数与Ewing试验参数及心率变异性(HRV)的相关性进行Pearson相关分析,并应用受试者工作特征(ROC)曲线评价角膜神经参数对DCAN的诊断价值。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)在DCAN组较非DCAN组显著下降,非DCAN组较正常对照组显著下降。调整年龄、病程、糖化血红蛋白、体质指数后,角膜神经参数与Ewing试验总分(r=-0.739^-0.576,P=0.000)、深呼吸心率差(r=0.284~0.442,P=0.000~0.013)具有显著相关性,CNFD与心率变异性的各项指标显著相关(r=0.254~0.450,P=0.000~0.028)。采用角膜共焦显微镜诊断DCAN的ROC曲线下面积为0.890~0.939,CNFD及CNBD的诊断灵敏度及特异度均在80%以上。结论采用角膜共焦显微镜检测角膜神经纤维形态改变可促进DCAN的早期诊断,角膜共焦显微镜是DCAN诊断方法的有益补充。Objective To investigate the relationship between corneal nerve fibers and diabetic cardiac autonomic neuropathy (DCAN), and explore the early diagnosis of DCAN. Methods From September 2017 to March 2018, 62 inpatients with diabetes mellitus [28 males, 34 females, average age (57±13) years] and 20 healthy volunteers [8 males, 12 females, and average age (52±8) years] were enrolled. The Ewing test, 24 h dynamic electrocardiogram, and in vivo corneal confocal microscopy (IVCCM) were performed. According to Ewing test, diabetic patients were divided into DCAN group (n=30) and non-DCAN group (n=32). The differences of corneal nerve parameters between DCAN group, non-DCAN group and normal control group were compared. The correlation between corneal nerve parameters and Ewing test parameters and heart rate variability (HRV) parameters was analyzed. The diagnostic value of corneal nerve parameters for DCAN was evaluated by receiver operating characteristic (ROC) curve. ResultsCorneal nerve parameters in the DCAN group were significantly lower than those in the non-DCAN group, while those in the non-DCAN group were significantly lower than those in the control group. After adjusting age, duration of disease, glycated hemoglobin A1c and body mass index, corneal nerve parameters were significantly correlated with total Ewing score (r=-0.739--0.576, P=0.000) and deep breathing heart rate difference (r=0.284-0.442, P=0.000~0.013). CNFD was significantly correlated with HRV index (r=0.254-0.450, P=0.000-0.028). The area under the ROC curve of the corneal nerve parameters used to diagnose DCAN ranged from 0.890 to 0.939. The diagnostic sensitivity and specificity of CNFD and CNBD were above 80%. Conclusions The corneal confocal microscopy could promote the early diagnosis of DCAN. IVCCM is a useful supplement to DCAN diagnostic methods.

关 键 词：糖尿病神经病变 早期诊断 角膜共焦显微镜 

分 类 号：R587.2[医药卫生—内分泌]