Computerized nailfold video‐capillaroscopy in type 2 diabetes: A cross‐sectional study on 102 outpatients Translated title: 计算机化甲襞视频毛细血管镜在2型糖尿病中的运用: 对102例门诊患者的横断面研究

Abstract

Background

Type 2 diabetes (T2D) is a chronic disease that negatively affects vascular health. A careful assessment of chronic complications, including microcirculation, is mandatory. The computerized nailfold video‐capillaroscopy (CNVC) accurately examines the nailfold microvasculature, but its suitability in T2D is currently under investigation.

Aims

To describe nailfold microvasculature in T2D patients regarding the level of glucose control and chronic microvascular and macrovascular complications.

Methods

This is a cross‐sectional study on 102 consecutive and unselected outpatients with T2D who had undergone CNVC examination. The examination was carried out by using an electronic video‐capillaroscope with 300x magnification. Capillaroscopic appearance and capillary changes were described according to well‐established parameters. Capillaroscopic parameters were compared between patients with poor glucose control (HbA1c ≥7%) and those with better glucose control (HbA1c <7%) and between patients with chronic complications and those without. Chronic complications were deduced from the anamnestic, laboratory, and instrumental data and the five‐item International Index of Erectile Function (IIEF‐5) questionnaire.

Results

Nailfold capillaries in patients with HbA1c ≥7% were thicker ( p = .019) and longer ( p = .021) than in those with better glucose control. Ectasias ( p = .017) and microaneurysms ( p = .045) were more frequently observed in patients with HbA1c ≥7.0% than those with HbA1c <7.0%. Patients with ED, compared to those without, had a lower frequency of bizarre‐shaped capillaries ( p = .02). Microaneurysms ( p = .02) were more frequently described in patients with carotid stenosis (>20%) than those without.

Conclusion

Relevant nailfold microvascular alterations were observed in T2D, most of which were associated with poor glycemic control, ED, and carotid stenosis. Further investigation is needed to recognize the role of CNVC in predicting the onset and evolution of chronic complications and monitoring the effectiveness of antihyperglycemic treatments on microcirculation.

Abstract

Highlights

• Patients with type 2 diabetes (T2D) are prone to developing chronic diabetes‐related complications at the microvascular and macrovascular levels. The Computerized Nailfold Video‐Capillaroscopy (CNVC) provides specific information on both quantitative and qualitative characteristics of microvasculature at the level of fingers.

• The present study aims to characterize nailfold microvascular changes in T2D patients and better describe specific nailfold patterns related to poor glucose control (ie, HbA1c ≥7%) and chronic complications, such as diabetic retinopathy, chronic kidney impairment, atherosclerosis, established cardiovascular disease, and erectile dysfunction (ED). This cross‐sectional cohort study was conducted on 102 consecutive and unselected outpatients with T2D. Patients underwent a comprehensive assessment of nailfold microvasculature by CNVC.

• Specific patterns of nailfold microvascular alteration are observed in T2D, such as tortuosity, ectasias, microaneurysms, and enlarged capillaries. Poor glycemic control is associated with dilated and longer capillaries and a higher frequency of ectasias and microaneurysms. Men with ED had fewer bizarre‐shaped capillaries (a sign of impaired angiogenesis), and those with clinical signs of atherosclerosis (ie, carotid stenosis >20%) had more microaneurysms. Future studies are needed to understand better the role of the CNVC in identifying at‐risk patients requiring specific therapeutic management to prevent the onset and evolution of severe chronic complications.

摘要

背景: 2型糖尿病（T2D）是一种对血管健康产生负面影响的慢性疾病。对慢性并发症、包括微循环的仔细评估是必须的。计算机化甲襞视频毛细血管镜（CNVC）能够准确检查甲襞微血管，但其是否适合用于T2D尚待研究。本文旨在描述T2D患者的甲襞微血管，探讨血糖控制水平以及慢性微血管和大血管并发症对其的影响。

方法: 这是一项针对102名连续且未经筛选的T2D门诊患者的横断面研究，所有患者均接受CNVC检查。使用电子视频毛细血管镜以300倍的放大率进行检查。根据已确定的参数描述毛细血管镜下外观和毛细血管改变。将毛细血管镜参数在血糖控制不佳（HbA1c≥7%）和血糖控制较好（HbA1c<7%）的患者之间以及有慢性并发症和无慢性并发症的患者之间进行比较。慢性并发症根据病史、实验室和仪器数据以及国际勃起功能指数（IIEF‐5）问卷进行推断。

结果: HbA1c≥7%患者的甲襞毛细血管较厚（p=0.019）且更长（p=0.021），与血糖控制较好的患者相比。HbA1c≥7.0%的患者中毛细血管扩张（p=0.017）和微动脉瘤（p=0.045）的发生率高于HbA1c<7.0%。与无ED患者相比，有ED的患者奇异形状毛细血管的发生率较低（p=0.02）。伴有颈动脉狭窄>20%的患者中微动脉瘤的发生率较高（p=0.02）。

结论: 在2型糖尿病患者中观察到相关的甲襞微血管改变，其中大多数与血糖控制不佳、ED和颈动脉狭窄有关。需要进一步调查以认识到CNVC在预测慢性并发症的发生和进展以及监测抗高血糖药物治疗对微循环的有效性中所起的作用。