Diabetic Neuropathy and Axon Reflex-Mediated Neurogenic Vasodilatation in Type 1 Diabetes 英文参考文献.docVIP

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Diabetic Neuropathy and Axon Reflex-Mediated Neurogenic Vasodilatation in Type 1 Diabetes 英文参考文献.doc

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Diabetic Neuropathy and Axon Reflex-Mediated Neurogenic Vasodilatation in Type 1 Diabetes 英文参考文献

DiabeticNeuropathyandAxonReflex-Mediated NeurogenicVasodilatationinType1Diabetes MaryamNabaviNouri2.,AusmaAhmed1.,VeraBril2,AndrejOrszag1,EduardoNg2,PattiNwe2, BruceA.Perkins1* 1DivisionofEndocrinologyandMetabolism,DepartmentofMedicine,UniversityofToronto,Toronto,Ontario,Canada,2DivisionofNeurology,DepartmentofMedicine, UniversityofToronto,Toronto,Ontario,Canada Abstract Objective:Axonreflex-mediatedneurogenicvasodilatationinresponsetocutaneousheatingmayreflectearly,pre-clinical smallfibredysfunction.Weaimedtoevaluatethedistributionofthevascularflareareameasuredbylaserdopplerimaging (‘‘LDIFLARE area’’)intype1diabetesandinhealthyvolunteers. Research and Methods: Concurrent with clinical and electrophysiological examination to classify diabetic sensorimotor polyneuropathy(DSP),LDIFLAREarea(cm2)wasdeterminedin89type1diabetessubjectsmatchedto64healthyvolunteers. We examined the association and diagnostic performance of LDI with clinical and subclinical measures of DSP and its severity. Results:Comparedtothe64healthyvolunteers,the56diabetescontrolswithoutDSPhadsignificantlylowerLDIFLARE area (p=0.006). The 33 diabetes cases with DSP had substantially lower LDIFLARE area as compared to controls without DSP (p=0.002).TherewasconsiderableoverlapinLDIFLAREareabetweenallgroupssuchthattheROCcurvehadanAUCof0.72 and optimal sensitivity of 70% for the detection of clinical DSP. Use of a subclinical definition for DSP, according to subclinicalsuralnerveimpairment,wasassociatedwithimprovedAUCof0.75andsensitivityof79%.Inmultivariateanalysis higherHbA1candbodymassindexhadindependentassociationswithsmallerLDIFLARE area. Conclusions: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating is a biomarker of early nerve dysfunction in DSP. Its independent association with glycemic exposure in diabetes subjects and both glycemic exposureandBMIinhealthyvolunteershighlightstheexistenceofsmall-fibredysfunctioninthenaturalhistoryofDSP. Citation:NabaviNouriM,AhmedA,Br