학술논문
The epidermal nerve fiber density measured by skin biopsy with diabetic patients correlated with clinical foot examination
Document Type
Article
Author
Source
International Congress of Diabetes and Metabolism. Oct 13, 2018 2018:196
Subject
Language
English
Abstract
Objective: Neuropathic pain is one of the most common reasons for a patient to seek medical attention. In a clinical and skin biopsy study designed to investigate whether changes in IENF density are directly related to pain. Methods: We enrolled 30 diabetic patients and all patients underwent clinical foot examination. Skin biopsy was used to measure nerves immunoreactive to the general neuronal marker PGP 9.5 in standardised leg skin biopsies of diabetic patients, and their linear density was quantified with bright-field microscopy. Results: We studied 30 diabetic patients with mean age was 49.07 ± 4.09, mean diabetes duration was 9.46 ± 5.74 years (0~23 years) and mean Hb1AC level was 9.81 ± 1.90%. Among diabetic patients with poorly controlled or HbA1C level > 7.5% was 94% and clinical examination with DPN was 83.3%. Mean IENFD in 1 mm area was 7.87 ± 4.72 (T1DM was 6.44 ± 2.83, and T2DM was 8.48 ± 5.27) nerve fiber. If IENFD was diagnosed > 12 nerve fiber in 1 mm area which is no peripheral neuropathy and < 12 nerve fiber in 1 mm area which is peripheral neuropathy. Among diabetic patients with DPN was 86.7%. IENFD was decreased 100% in T1DM patients and 87% in T2DM patients. IENFD progressively decreased in patients with neuropathy (P < 0.001). Diabetic peripheral neuropathy was correlated with diabetic duration (V = 0.876, p < 0.0001) and HbA1C level (V = 0.760, p < 0.0001). IENFD was not significantly altered in diabetic patients of < 5 years duration, but significantly decreased in patients with > 5 years duration. IENFD showed significant positive correlations with warm (P < 0.0235) and cold (P < 0.05) thermal threshold, painful and sensor sense. Although negative correlations with pressure sense (P < 0.067) Conclusion: IENFD was significantly altered in these patients at more than 5 years duration of diabetes. The association was strongly correlated between IENFD and diabetic peripheral neuropathy by clinical examination with diabetic patients. No difference was found in IENFD between patients with and without neuropathic pain.