Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome
Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome
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DOI：
10.1016/j.pain.2005.10.035
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发表时间：
2006-02-01
期刊：
影响因子：
7.4
通讯作者：
Rice, FL
中科院分区：
文献类型：
--
作者：
Albrecht, PJ;Hines, S;Rice, FL
复杂区域疼痛综合征（CRPS，I型和II型）是软组织（CRPS I型）或神经（CRPS II型）损伤后可能发生的破坏性疾病。CRPS I型，也称为反射性交感神经营养不良，存在于缺乏明确神经病变的患者中，并且一直质疑它是否是具有器质性基础的真正神经病性病症。如本文所述，使用一组针对神经相关蛋白和伤害感受感觉功能介质的抗体，对来自两名CRPS I型诊断患者的截肢上肢和下肢的无毛和有毛皮肤样品进行双标记免疫荧光处理。在CRPS受累的皮肤中，检测到几种神经病理学改变，包括：（1）存在许多异常的细口径NF阳性/MBP阴性轴突支配毛囊;（2）表皮、汗腺和血管神经支配减少;（3）对血管和汗腺的剩余神经支配的CGRP表达丧失;（4）神经肽Y在浅动脉和汗腺的神经支配上的不适当表达;（5）血管内皮完整性的丧失和异常的血管肥大。结果是广泛的皮肤神经病理变化的证据。重要的是，在这些CRPS I型患者中，观察到的无数临床症状具有可检测的神经病理学相关性。(c)2005年国际疼痛研究协会。Elsevier B.V.出版，保留所有权利。
Complex regional pain syndromes (CRPS, type I and type II) are devastating conditions that can occur following soft tissue (CRPS type I) or nerve (CRPS type II) injury. CRPS type I, also known as reflex sympathetic dystrophy, presents in patients lacking a well-defined nerve lesion, and has been questioned as to whether or not it is a true neuropathic condition with an organic basis. As described here, glabrous and hairy skin samples from the amputated upper and lower extremity from two CRPS type I diagnosed patients were processed for double-label immunofluorescence using a battery of antibodies directed against neural-related proteins and mediators of nociceptive sensory function. In CRPS affected skin, several neuropathologic alterations were detected, including: (1) the presence of numerous abnormal thin caliber NF-positive/MBP-negative axons innervating hair follicles; (2) a decrease in epidermal, sweat gland, and vascular innervation; (3) a loss of CGRP expression on remaining innervation to vasculature and sweat glands; (4) an inappropriate expression of NPY on innervation to superficial arterioles and sweat glands; and (5) a loss of vascular endothelial integrity and extraordinary vascular hypertrophy. The results are evidence of widespread cutaneous neuropathologic changes. Importantly, in these CRPS type I patients, the myriad of clinical symptoms observed had detectable neuropathologic correlates. (c) 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.