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1.
Objectives
To determine whether neuropathy in diabetic patients with normal nerve conduction studies could be detected by measurements
of thermal thresholds and quantification of intraepidermal nerve fibre (IENF) density, and to evaluate differences in parameters
between patients with and without neuropathic symptoms.
Methods
A total of 22 patients with and 37 patients without sensory symptoms suggesting distal neuropathy were included. Measurements
of warm and cold perception thresholds and skin biopsy for quantification of IENFs were performed distally on the leg. Reference
data were used to normalize test results for age and height or gender of individual patients by calculating the Z-scores.
Results
IENF density was significantly reduced in both symptomatic and asymptomatic patients compared to controls (p < 0.001), and
in patients with symptoms compared to those without (p = 0.01). Thermal thresholds were significantly elevated (more abnormal)
in patients with symptoms compared to controls (p < 0.01), but only for cold perception threshold (CPT) (p < 0.001) in the
asymptomatic group. When comparing symptomatic and asymptomatic patients, there was no statistically significant difference
in thermal thresholds. Depletion of IENFs in skin biopsy was the most frequent abnormal finding in the subgroup of patients
with neuropathic symptoms (36 %) followed by abnormal CPT (27 %).
Conclusion
Patients with diabetes and normal nerve conduction studies had significantly lower IENF density and higher CPT than controls,
whether they had symptoms of polyneuropathy or not. In patients with neuropathic symptoms, abnormal IENF density predominated
and seemed thus to be the most sensitive tool of detecting small diameter nerve fibre involvement. 相似文献