Reduced intraepidermal nerve fiber density in patients with chronic ischemic pain in peripheral arterial disease
Reduced intraepidermal nerve fiber density in patients with chronic ischemic pain in peripheral arterial disease
复制标题
DOI：
10.1016/j.pain.2014.06.003
复制
发表时间：
2014-09-01
期刊：
影响因子：
7.4
通讯作者：
Lang, Philip M.
中科院分区：
文献类型：
--
作者：
Groene, Eva;Ueceyler, Nurcan;Lang, Philip M.
外周动脉疾病(PAD)中的慢性缺血性疼痛是导致下肢疼痛的主要原因。慢性缺血性疼痛的一种神经病理成分已被证明与共存的糖尿病无关。我们的目标是确定PAD中可能与疼痛和感觉缺陷相关的形态相关性。40例症状性PAD患者(Fontaine分期II-IV期)，20例间歇性跛行(CI)患者和20例严重肢体缺血(CLI)患者，12名志愿者作为健康对照组。所有患者都接受了疼痛评分和问卷调查。所有研究参与者都接受了小腿远端的定量感觉测试(QST)和小腿远端的皮肤穿孔活检，以确定表皮内神经纤维密度(IENFD)。此外，还测量了血清S100β水平，作为缺血性神经损伤的潜在标记物。神经病理性疼痛问卷显示，与CI患者相比，CLI患者的评分略高，疼痛导致的残疾更明显。QST显示热和机械检测痛阈值升高，以及动态机械超敏，特别是在晚期疾病患者中。与对照组相比，PAD组的IENFD减少(P<；0.05)，在CLI亚组更为明显(CLI：1.3+/-0.5个纤维/mm，CI：2.9+/-0.5个纤维/mm，对照组：5.3+/-0.6个纤维/mm)。特别是，机械痛阈值和热痛阈值的增加与IENFD的降低呈负相关。平均S100β水平在正常范围内，但在晚期疾病中水平较高。慢性缺血性疼痛患者的IENFD减少与感觉功能受损有关。这些发现支持了缺血性疼痛中的神经病理成分的概念。(C)2014年国际疼痛研究协会。爱思唯尔出版，版权所有。
Chronic ischemic pain in peripheral arterial disease (PAD) is a leading cause of pain in the lower extremities. A neuropathic component of chronic ischemic pain has been shown independent of coexisting diabetes. We aimed to identify a morphological correlate potentially associated with pain and sensory deficits in PAD. Forty patients with symptomatic PAD (Fontaine stages II-IV), 20 with intermittent claudication (CI), and 20 with critical limb ischemia (CLI) were enrolled; 12 volunteers served as healthy controls. All patients were examined using pain scales and questionnaires. All study participants underwent quantitative sensory testing (QST) at the distal calf and skin punch biopsy at the distal leg for determination of intraepidermal nerve fiber density (IENFD). Additionally, S100beta serum levels were measured as a potential marker for ischemic nerve damage. Neuropathic pain questionnaires revealed slightly higher scores and more pronounced pain-induced disability in CLI patients compared to CI patients. QST showed elevated thermal and mechanical detection pain thresholds as well as dynamic mechanical allodynia, particularly in patients with advanced disease. IENFD was reduced in PAD compared to controls (P < 0.05), more pronounced in the CLI subgroup (CLI: 1.3 +/- 0.5 fibers/mm, CI: 2.9 +/- 0.5 fibers/mm, controls: 5.3 +/- 0.6 fibers/mm). In particular, increased mechanical and heat pain thresholds negatively correlated with lower IENFD. Mean S100beta levels were in the normal range but were higher in advanced disease. Patients with chronic ischemic pain had a reduced IENFD associated with impaired sensory functions. These findings support the concept of a neuropathic component in ischemic pain. (C) 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.