Microangiopathy in human diabetic neuropathy.
Microangiopathy in human diabetic neuropathy.
复制标题
人类糖尿病神经病变中的微血管病变。
DOI：
10.1007/bf00690832
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发表时间：
1985
影响因子：
12.7
通讯作者：
Myers,RR
中科院分区：
文献类型：
--
作者：
Powell,HC;Rosoff,J;Myers,RR
17 名糖尿病神经病变患者的神经内膜和神经周围血管的形态学变化都伴随着周围神经有髓鞘轴突的严重丧失。糖尿病毛细血管 (n=11) 的血管壁平均增厚为 18.9±9.9 μm2，而对照组 (n=7) 为 6.9±4.1 μm2。电子显微镜显示在每种情况下内皮细胞增殖旺盛以及基底层增厚和重复。特别关注穿过神经束膜到达神经内膜间质的血管，因为它们提供了神经内膜血液供应的主要部分。这些血管的管腔变窄和壁增厚与神经束膜的基底层状增厚相结合。在一例病例中发现有窗的神经内膜毛细血管内皮。在一些轴突中观察到脱髓鞘和轴突变性，轴突内糖原积累。形态测量分析显示糖尿病神经中广泛的有髓神经纤维损失。这些形态学发现强调了糖尿病微血管病对特化内皮的影响，并表明神经束膜的局部解剖因素使神经容易遭受慢性缺血。
Morphological change of endoneurial and perineurial vessels accompanied severe loss of myelinated axons in peripheral nerves of each of 17 patients with diabetic neuropathy. Vascular mural thickening averaged 18.9±9.9 μm2in diabetic capillaries (n=11) vs. 6.9±4.1 μm2in controls (n=7). Electron microscopy revealed vigorous endothelial proliferation as well as thickening and reduplication of basal lamina in each instance. Particular attention was paid to vessels which penetrate the perineurium en route to the endoneurial intertitium, since they provide a major portion of the endoneurial blood supply. Luminal narrowing and mural thickening of these vessels was compounded by basal laminar thickening of the perineurium. Fenestrated endoneurial capillary endothelium was noted in one case. Both demyelination and axonal degeneration were observed with intra-axonal glycogen accumulation in some axons. Morphometric analysis revealed extensive myelinated nerve fiber loss in diabetic nerves. These morphological findings emphasize the impact of diabetic microangiopathy on specialized endothelium and suggest that local anatomic factors in the perineurial sheath render the nerve vulnerable to chronic ischemia.