Small Nerve Fiber Quantification in the Diagnosis of Diabetic Sensorimotor Polyneuropathy: Comparing Corneal Confocal Microscopy With Intraepidermal Nerve Fiber Density

被引:198
作者
Chen, Xin [1 ]
Graham, Jim [1 ]
Dabbah, Mohammad A. [1 ]
Petropoulos, Ioannis N. [2 ,3 ]
Ponirakis, Georgios [2 ,3 ]
Asghar, Omar [2 ,3 ]
Alam, Uazman [2 ,3 ]
Marshall, Andrew [4 ]
Fadavi, Hassan [2 ,3 ]
Ferdousi, Maryam [2 ,3 ]
Azmi, Shazli [2 ,3 ]
Tavakoli, Mitra [2 ,3 ]
Efron, Nathan [5 ]
Jeziorska, Maria [2 ,3 ]
Malik, Rayaz A. [2 ,3 ]
机构
[1] Univ Manchester, Inst Populat Hlth, Ctr Imaging Sci, Manchester, Lancs, England
[2] Manchester Acad Hlth Sci Ctr, Inst Human Dev, Ctr Endocrinol & Diabet, Manchester, Lancs, England
[3] Weill Cornell Med Coll Qatar, Div Med, Doha, Qatar
[4] Cent Manchester NHS Fdn Trust, Dept Clin Neurophysiol, Manchester, Lancs, England
[5] Queensland Univ Technol, Inst Hlth & Biomed Innovat, Brisbane, Qld 4001, Australia
基金
美国国家卫生研究院;
关键词
IMPAIRED GLUCOSE-TOLERANCE; PERIPHERAL NEUROPATHY; MULTICENTER; PREVALENCE; TRIAL; REGENERATION; PROFICIENCY; POPULATION; CONDUCTION; MORPHOLOGY;
D O I
10.2337/dc14-2422
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard. RESEARCH DESIGN AND METHODS Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy. RESULTS Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14). CONCLUSIONS This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN.
引用
收藏
页码:1138 / 1144
页数:7
相关论文
共 35 条
[1]   Prevalence and Characteristics of Painful Diabetic Neuropathy in a Large Community-Based Diabetic Population in the UK [J].
Abbott, Caroline A. ;
Malik, Rayaz A. ;
van Ross, Ernest R. E. ;
Kulkarni, Jai ;
Boulton, Andrew J. M. .
DIABETES CARE, 2011, 34 (10) :2220-2224
[2]   Corneal Confocal Microscopy Detects Neuropathy in Subjects With Impaired Glucose Tolerance [J].
Asghar, Omar ;
Petropoulos, Ioannis N. ;
Alam, Uazman ;
Jones, Wendy ;
Jeziorska, Maria ;
Marshall, Andrew ;
Ponirakis, Georgios ;
Fadavi, Hassan ;
Boulton, Andrew J. M. ;
Tavakoli, Mitra ;
Malik, Rayaz A. .
DIABETES CARE, 2014, 37 (09) :2643-2646
[3]   Whither pathogenetic treatments for diabetic polyneuropathy? [J].
Boulton, Andrew J. M. ;
Kempler, Peter ;
Ametov, Alexander ;
Ziegler, Dan .
DIABETES-METABOLISM RESEARCH AND REVIEWS, 2013, 29 (05) :327-333
[4]   Does the Prevailing Hypothesis That Small- Fiber Dysfunction Precedes Large- Fiber Dysfunction Apply to Type 1 Diabetic Patients? [J].
Breiner, Ari ;
Lovblom, Leif Erik ;
Perkins, Bruce A. ;
Bril, Vera .
DIABETES CARE, 2014, 37 (05) :1418-1424
[5]   Automatic analysis of diabetic peripheral neuropathy using multi-scale quantitative morphology of nerve fibres in corneal confocal microscopy imaging [J].
Dabbah, M. A. ;
Graham, J. ;
Petropoulos, I. N. ;
Tavakoli, M. ;
Malik, R. A. .
MEDICAL IMAGE ANALYSIS, 2011, 15 (05) :738-747
[6]  
Dabbah MA, 2010, LECT NOTES COMPUT SC, V6361, P300
[7]   Fully Automated, Semiautomated, and Manual Morphometric Analysis of Corneal Subbasal Nerve Plexus in Individuals With and Without Diabetes [J].
Dehghani, Cirous ;
Pritchard, Nicola ;
Edwards, Katie ;
Russell, Anthony W. ;
Malik, Rayaz A. ;
Efron, Nathan .
CORNEA, 2014, 33 (07) :696-702
[8]   Challenges in design of multicenter trials [J].
Dyck, Peter J. ;
Norell, Jane E. ;
Tritschler, Hans ;
Schuette, Klemens ;
Samigullin, Rustem ;
Ziegler, Dan ;
Bastyr, Edward J., III ;
Litchy, William J. ;
O'Brien, Peter C. .
DIABETES CARE, 2007, 30 (10) :2619-2625
[9]   MULTICENTER TRIAL OF THE PROFICIENCY OF SMART QUANTITATIVE SENSATION TESTS [J].
Dyck, Peter J. ;
Argyros, Barbara ;
Russell, James W. ;
Gahnstrom, Linde E. ;
Nalepa, Susan ;
Albers, James W. ;
Lodermeier, Karen A. ;
Zafft, Andrew J. ;
Dyck, P. James B. ;
Klein, Christopher J. ;
Litchy, William J. ;
Davies, Jenny L. ;
Carter, Rickey E. ;
Melton, L. Joseph, III .
MUSCLE & NERVE, 2014, 49 (05) :645-653
[10]   Assessing Decreased Sensation and Increased Sensory Phenomena in Diabetic Polyneuropathies [J].
Dyck, Peter J. ;
Herrmann, David N. ;
Staff, Nathan P. ;
Dyck, P. James B. .
DIABETES, 2013, 62 (11) :3677-3686