Reduction of skin innervation is associated with a severe fibromyalgia phenotype
Reduction of skin innervation is associated with a severe fibromyalgia phenotype
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DOI：
10.1002/ana.25565
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发表时间：
2019-08-21
影响因子：
11.2
通讯作者：
Uceyler, Nurcan
中科院分区：
文献类型：
--
作者：
Evdokimov, Dimitar;Frank, Johanna;Uceyler, Nurcan
目的探讨纤维肌痛综合征（FMS）患者小神经纤维功能障碍的类型及影响。方法117例女性FMS患者接受神经系统检查、问卷评估、神经生理学评估和小纤维测试：皮肤穿刺活检、角膜共焦显微镜、显微神经造影、定量感觉测试（包括C-触觉传入和疼痛相关诱发电位）。这些数据进行了比较，与妇女的抑郁症和慢性广泛性疼痛（MD-P）和健康妇女。结果63%的FMS患者不同活检部位的表皮内神经纤维密度（IENFD）降低（MD-P：10%，对照组：18%; P < 0.001）。我们发现FMS中的皮肤神经支配有4种模式：正常、远端减少、近端减少和远端和近端都减少（与对照组相比，每种模式p < 0.01）。神经电图显示FMS患者除了1B纤维自发活动和机械致敏外，1A纤维在低频刺激时传导速度的初始活动依赖性加速。与对照组相比，FMS患者的体温检测阈值升高（p < 0.01），C-触觉传入受损（p < 0.05），疼痛相关诱发电位振幅降低（p < 0.001）。与皮肤神经支配正常的FMS患者相比，广泛IENFD减少的患者具有更高的疼痛强度和疼痛所致的损害，更高的疾病负担，更多的刺痛和感觉异常，以及更多的焦虑（p < 0.05）。眼内神经功能减退的FMS患者角膜神经纤维密度和长度也较低（p < 0.01和p < 0.05）。小纤维病变的程度与FMS的症状严重程度有关。这些知识可能对FMS患者的诊断分类和治疗有影响。2019年安神经
Objective To assess patterns and impact of small nerve fiber dysfunction and pathology in patients with fibromyalgia syndrome (FMS). Methods One hundred seventeen women with FMS underwent neurological examination, questionnaire assessment, neurophysiology assessment, and small fiber tests: skin punch biopsy, corneal confocal microscopy, microneurography, quantitative sensory testing including C-tactile afferents, and pain-related evoked potentials. Data were compared with those of women with major depressive disorder and chronic widespread pain (MD-P) and healthy women. Results Intraepidermal nerve fiber density (IENFD) was reduced at different biopsy sites in 63% of FMS patients (MD-P: 10%, controls: 18%; p < 0.001 for each). We found 4 patterns of skin innervation in FMS: normal, distally reduced, proximally reduced, and both distally and proximally reduced (p < 0.01 for each compared to controls). Microneurography revealed initial activity-dependent acceleration of conduction velocity upon low frequencies of stimulation in 1A fibers, besides 1B fiber spontaneous activity and mechanical sensitization in FMS patients. FMS patients had elevated warm detection thresholds (p < 0.01), impaired C-tactile afferents (p < 0.05), and reduced amplitudes (p < 0.001) of pain-related evoked potentials compared to controls. Compared to FMS patients with normal skin innervation, those with generalized IENFD reduction had higher pain intensity and impairment due to pain, higher disease burden, more stabbing pain and paresthesias, and more anxiety (p < 0.05 for each). FMS patients with generalized IENFD reduction also had lower corneal nerve fiber density (p < 0.01) and length (p < 0.05). Interpretation The extent of small fiber pathology is related to symptom severity in FMS. This knowledge may have implications for the diagnostic classification and treatment of patients with FMS. ANN NEUROL 2019