% 0期刊文章%桑德拉·穆斯塔法Itani想知道% s Gylfadottir %亚历山大·g·Kristensen % Jens R . Nyengaard % Søren嗯Sindrup %我s . Jensen % b奶奶。Finnerup %笼罩在Karlsson % T评估角膜共焦显微镜和其他小型纤维措施糖尿病多神经病% D R 10.1212 / WNL 2023%。0000000000206902 % J首页神经病学% P e1680-e1690 % V 100% N 16% X背景和目标小神经纤维损伤常见于糖尿病多神经病(DPN)和糖尿病周围神经病变的诊断依赖于主观症状和体征结合客观验证性测试,通常电生理学或表皮内的神经纤维密度(IENFD)皮肤活检。角膜共焦显微镜(CCM)介绍了作为一种工具来检测DPN。然而,目前还不清楚如果CCM能够可靠地诊断DPN以及技术与其他常用的小纤维损伤的措施,如IENFD、冷检测阈值(CDT),和温暖的检测阈值(WDT)。因此,我们评估和CCM的使用相比,IENFD, CDT, WDT DPN诊断的2型糖尿病患者。在这个队列研究方法,参与者进行了详尽的神经系统检查,电生理学,量化IENFD, CCM和定量感觉测试。多伦多DPN的定义是按照标准糖尿病神经病变(不依赖IENFD和热阈值)。结果共有214名至少可能DPN患者,63例患者没有DPN,和97名非糖尿病控制包括在内。DPN患者较低CCM措施(角膜神经纤维长度(CNFL),神经纤维密度,和分支密度),IENFD, CDT, WDT相比没有DPN患者(p≤0.001 < 0.001, 0.002, p < 0.001, p = 0.003 < 0.005),而没有控制和糖尿病患者没有DPN的区别。所有3 CCM措施显示非常低的诊断敏感性CNFL显示最高(14.4% (95% CI 9.8 - -18.4))和特异性为95.7% (88.0 - -99.1)。相比之下,CDT和/或WDT异常的敏感性为30.5%(24.4 - -37.0)的特异性为84.9% (74.6 - -92.2)。 The sensitivity of abnormal IENFD was highest among all measures with a value of 51.1% (43.7–58.5) and a specificity of 90% (79.5–96.2). CCM measures did not correlate with IENFD, CDT/WDT, or neuropathy severity in the group of patients with DPN.Discussion CCM measures showed the lowest sensitivity compared with other small fiber measures in the diagnosis of DPN. This indicates that CCM is not a sensitive method to detect DPN in recently diagnosed type 2 diabetes.Classification of Evidence This study provides Class III evidence that CCM measures aid in the detection of DPN in recently diagnosed type 2 diabetics but with a low sensitivity when compared with other small fiber measures.AUC=area under the curve; BMI=body mass index; CCM=corneal confocal microscopy; CDT=cold detection threshold; CNBD=corneal nerve branch density; CNFD=corneal nerve fiber density; CNFL=corneal nerve fiber length; DPN=diabetic polyneuropathy; IENFD=intraepidermal nerve fiber density; IQR=interquartile range; LFN=large fiber neuropathy; MFN=mixed fiber neuropathy; NCS=nerve conduction studies; ROC=receiver operation characteristics; SFN=small fiber neuropathy; TCNS=Toronto Clinical Neuropathy Score; WDT=warm detection threshold %U //www.ez-admanager.com/content/neurology/100/16/e1680.full.pdf