Morphological diversity of the corneal small fibers in patients with type 1 diabetes mellitus

IF 1.1 Q4 IMMUNOLOGY Immunopathologia Persa Pub Date : 2022-04-17 DOI:10.34172/ipp.2022.31336
Anna Bregovskaya, M. Lukashenko, E. Kamaeva, N. Gavrilova, L. Soprun, N. Grigoryeva, I. Pchelin, L. Churilov
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Abstract

Introduction: Diabetic neuropathy (DN) affects up to 50% of patients with type 1 diabetes mellitus (T1DM). Clinical manifestations include painful polyneuropathy with autonomic and orthostatic symptoms. Corneal confocal microscopy (CCM) is one of the promising non-invasive methods for DN evaluation and tracking the effectiveness of treatment. Objectives: To perform the early diagnosis of DN in T1DM patients and describe the morphological changes in nerve fibers during the treatment process. Patients and Methods: This prospective study included 77 T1DM patients and 42 healthy controls. All patients underwent CCM and electroneuromyography (ENMG). Twenty-five patients with T1DM and HbA1c 7-10% underwent strict glycemic control with the correction of insulin therapy and the subsequent CCM and ENMG investigations for the second time. Results: In T1DM patients a decrease in the main nerve trunks with age was revealed, as well as an increase in corneal nerve tortuosity (P<0.05). The number of branches of nerve fibers did not change with the increasing age (P=0.07). After reaching T1DM compensation, patients underwent a course of alpha-lipoic acid therapy. Confocal microscopy of the cornea parameters did not undergo significant changes during therapy since significant positive dynamics were noted only in the tortuosity of nerve fibers (P<0.05), which decreased by 11.8%. Conclusion: In patients with T1DM, strict glycemic control, correction of insulin therapy, and courses of alpha-lipoic acid prescription help to reduce the morphological changes of small fiber neuropathy, which can be evaluated by the confocal microscopy of the cornea.
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1型糖尿病患者角膜小纤维的形态多样性
导读:糖尿病性神经病变(DN)影响高达50%的1型糖尿病(T1DM)患者。临床表现为疼痛性多神经病变伴自主和直立症状。角膜共聚焦显微镜(CCM)是一种很有前途的无创DN评估和跟踪治疗效果的方法。目的:对T1DM患者进行DN的早期诊断,描述治疗过程中神经纤维的形态学变化。患者和方法:本前瞻性研究纳入77例T1DM患者和42例健康对照。所有患者均行CCM和神经肌电图(ENMG)检查。25例T1DM和HbA1c 7-10%的患者接受了严格的血糖控制,并纠正了胰岛素治疗,随后进行了第二次CCM和ENMG检查。结果:T1DM患者主要神经干随年龄增加而减少,角膜神经扭曲增加(P<0.05)。神经纤维分支数不随年龄增长而变化(P=0.07)。在达到T1DM补偿后,患者接受一个疗程的α -硫辛酸治疗。治疗期间,角膜共聚焦显微镜参数没有发生显著变化,因为只有神经纤维扭曲出现显著的正动态变化(P<0.05),减少了11.8%。结论:T1DM患者严格控制血糖、纠正胰岛素治疗、连续疗程α -硫辛酸处方有助于减轻小纤维神经病变的形态学改变,可通过角膜共聚焦显微镜观察。
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来源期刊
CiteScore
1.70
自引率
0.00%
发文量
65
审稿时长
3 weeks
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