diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes糖尿病神经病变和轴突的神经源性血管舒张reflex-mediated 1型糖尿病.pdfVIP

Diabetic Neuropathy and Axon Reflex-Mediated Neurogenic Vasodilatation in Type 1 Diabetes 2. 1. 2 1 2 2 Maryam Nabavi Nouri , Ausma Ahmed , Vera Bril , Andrej Orszag , Eduardo Ng , Patti Nwe , Bruce A. Perkins1* 1 Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, 2 Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada Abstract Objective: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating may reflect early, pre-clinical small fibre dysfunction. We aimed to evaluate the distribution of the vascular flare area measured by laser doppler imaging (‘‘LDIFLARE area’’) in type 1 diabetes and in healthy volunteers. Research and Methods: Concurrent with clinical and electrophysiological examination to classify diabetic sensorimotor polyneuropathy (DSP), LDI 2 FLARE area (cm ) was determined in 89 type 1 diabetes subjects matched to 64 healthy volunteers. We examined the association and diagnostic performance of LDI with clinical and subclinical measures of DSP and its severity. Results: Compared to the 64 healthy volunteers, the 56 diabetes controls without DSP had significantly lower LDIFLARE area (p = 0.006). The 33 diabetes cases with DSP had substantially lower LDIFLARE area as compared to controls without DSP (p = 0.002). There was considerable overlap in LDIFLARE area between all groups such that the ROC curve had an AUC of 0.72 and optimal sensitivity of 70% for the detection of clinical DSP. Use of a subclinical definition for DSP, according to