目的:糖尿病周围神经病变可以使用非侵入性体内角膜共聚焦显微镜(IVCM)检测,并且这种异常可能在临床神经病变发展之前。本研究旨在评估接受减肥手术的2型糖尿病患者角膜和周围神经病变的进展或缓解情况。
方法:招募已知2型糖尿病患者至少5年并被列入减重手术名单。参与者之前进行了评估,12、26和52周后减肥手术。进行IVCM和角膜敏感性测量。从神经病变问卷中获得改良的总神经病变评分(mTNS),临床评估和生物测量学。
结果:29名参与者(M:F,11:18),平均BMI为44.7±6.4kg/m2,糖尿病持续时间为11±7.6年,被评估。角膜基底下神经纤维长度(CNFL),在52周时,基线平均值从12.20±1.00增加到17.48±0.92mm/mm2(p<0.0001)。角膜敏感度阈值显示随着时间的推移而下降,因此角膜敏感性得到改善,从平均值1.11±0.15下降到0.62±0.11(mBAR)(p<0.0001)。临床神经病变评分与基线相比有显著改善,显示平均mTNS评分从3.29±0.68降至0.76±0.30(p<0.0001)。CNFL和灵敏度之间存在显著的反比关系(β系数=-0.047,p<0.001),以及CNFL和mTNS(β系数=-0.178,p<0.001)。
结论:减肥手术改善了糖尿病的代谢控制和体重减轻,随着角膜神经微结构的改善,角膜敏感度,和神经性症状,提示小纤维神经病和大纤维神经病的逆转。
OBJECTIVE: Diabetic peripheral neuropathy can be detected using non-invasive in vivo confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery.
METHODS: People with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry.
RESULTS: Twenty-nine participants (M:F, 11:18) with mean BMI of 44.7 ± 6.4 kg/m2, and 11 ± 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 ± 1.00 to 17.48 ± 0.92 mm/mm2 at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 ±0 .15 to 0.62 ± 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 ± 0.68 to 0.76 ± 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity (β coefficient = -0.047, p < 0.001), and CNFL and mTNS (β coefficient = -0.178, p < 0.001).
CONCLUSIONS: Bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.