Increased sural nerve epineurial blood flow in human subjects with painful diabetic neuropathy
Increased sural nerve epineurial blood flow in human subjects with painful diabetic neuropathy
复制标题
DOI：
10.1007/s00125-003-1127-3
复制
发表时间：
2003-07-01
期刊：
影响因子：
8.2
通讯作者：
Tesfaye, S
中科院分区：
文献类型：
--
作者：
Eaton, SEM;Harris, ND;Tesfaye, S
目标/假设。疼痛性糖尿病神经病变的发病机制仍不清楚。因此，我们仍然没有任何有效、合理的治疗方法，迫切需要对其机制有更深入的了解。先前的研究表明，患有和不患有疼痛性神经病的患者的神经形态没有一致的差异。本研究的目的是比较慢性疼痛性和无痛性神经病患者的神经外血流动力学。方法。采用微光导分光光度法和荧光素血管造影技术分别测量神经外膜血管内氧饱和度和血流量。研究人员对 11 名疼痛性神经病患者和 8 名无痛性神经病患者进行了研究，各组在神经病严重程度和糖尿病控制方面进行了仔细匹配。结果。与无疼痛组相比，疼痛性神经病变组的血管内氧饱和度较高（中位值分别为 73.8% 和 67.7%；p=0.021）。在有疼痛症状的患者中，荧光素上升时间也更快（中位 18.3 秒 vs 53.6 秒；p=0.046），表明这些受试者的神经外膜血流量更高。结论/解释。这些结果表明，患有疼痛性和无痛性神经病的受试者腓肠神经外膜内的血流动力学存在明显差异。因此，血流动力学因素可能在神经性疼痛的发病机制中发挥重要作用，并可能为这种令人痛苦的疾病的潜在治疗提供进一步的见解。
Aims/hypothesis. The pathogenesis of painful diabetic neuropathy remains unknown. As a consequence we still do not have any effective, rational treatments and a greater understanding of the mechanisms is urgently required. Previous studies have shown no consistent morphological differences in the nerves of patients with and without painful neuropathy. The aim of this study was to compare epineurial haemodynamics in patients with chronic painful and painless neuropathy.Methods. The techniques of microlightguide spectrophotometry and fluorescein angiography were used to measure epineurial intravascular oxygen saturation and blood flow respectively. Eleven patients with painful and eight with painless neuropathy were studied, with the groups matched carefully in terms of severity of neuropathy and diabetes control.Results. Intravascular oxygen saturation was higher in the painful neuropathy group compared to those without pain (median 73.8% vs 67.7%, respectively; p=0.021). Fluorescein rise time was also faster in those with painful symptoms (median 18.3 s vs 53.6 s; p=0.046) indicating higher epineurial blood flow in these subjects.Conclusion/interpretation. These results indicate that there are distinct differences in haemodynamics within the epineurium of the sural nerve in subjects with painful and painless neuropathy. Haemodynamic factors could therefore have an important role in the pathogenesis of neuropathic pain and might offer further insight into potential treatments for this distressing condition.