Clinical, neurophysiological, and skin biopsy findings in peripheral neuropathy associated with hepatitis C virus-related cryoglobulinemia
Clinical, neurophysiological, and skin biopsy findings in peripheral neuropathy associated with hepatitis C virus-related cryoglobulinemia
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DOI：
10.1007/s00415-014-7261-7
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发表时间：
2014-04-01
影响因子：
6
通讯作者：
Truini, A.
中科院分区：
文献类型：
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作者：
Biasiotta, A.;Casato, M.;Truini, A.
丙型肝炎病毒(丙型肝炎病毒)相关的冷球蛋白血症通常会导致致残性并发症，包括周围神经病变和神经病理性疼痛。在这项前瞻性的临床、神经生理学和皮肤活检研究中，我们旨在评估丙型肝炎病毒相关性冷球蛋白血症患者周围神经病和神经病理性疼痛的临床特征和危险因素。我们连续招募了69名与丙型肝炎病毒相关的冷球蛋白血症患者。用神经病理性疼痛诊断问卷(DN4)诊断神经病理性疼痛，用神经病理性疼痛症状量表(NPSI)对各种神经病理性疼痛进行评分。所有患者都接受了标准的神经传导检查以评估Aβ纤维功能，激光诱发电位评估A增量纤维功能，皮肤活检评估C纤维终末。在研究的69名患者中，47名患者有周围神经病变，29名患者有神经病理性疼痛。有周围神经病变的患者比无周围神经病变的患者年龄大(P<；0.0001)。周围神经病变与丙型肝炎病毒感染的持续时间显著相关(P<；0.01)，与冷球蛋白血症和低温红细胞压积的持续时间无关(P>；0.5)。周围神经病变的严重程度与丙型肝炎病毒感染时间显著相关(P<；0.05)。神经病理性疼痛患者的激光诱发电位波幅明显低于无神经病理性疼痛患者(P<；0.05)。相反，在神经传导检查和皮肤活检结果方面没有发现差异(P>；0.05)。我们的发现表明，周围神经病变与年龄和丙型肝炎病毒感染有关，而不是与冷球蛋白血症有关，神经性疼痛与激光诱发电位评估的伤害性通路受损有关；这可能有助于设计更有效的临床干预措施来治疗这些常见的丙型肝炎病毒相关冷球蛋白血症并发症。
Hepatitis C virus (HCV)-related cryoglobulinemia commonly causes disabling complications including peripheral neuropathy and neuropathic pain. In this prospective clinical, neurophysiological, and skin biopsy study we aimed at assessing clinical characteristics and risk factors of peripheral neuropathy and neuropathic pain in patients with HCV-related cryoglobulinemia. We enrolled 69 consecutive patients with HCV-related cryoglobulinemia. We diagnosed neuropathic pain with the DN4 (Neuropathic Pain Diagnostic) questionnaire, and rated the various neuropathic pains with the Neuropathic Pain Symptom Inventory (NPSI). All patients underwent a standard nerve conduction study to assess A beta-fiber function, laser-evoked potentials to assess A delta-fiber function, and skin biopsy to assess C-fiber terminals. Of the 69 patients studied, 47 had a peripheral neuropathy, and 29 had neuropathic pain. Patients with peripheral neuropathy were older than those without (P < 0.0001). While peripheral neuropathy was significantly associated with the duration of HCV infection (P < 0.01), it was unrelated to the duration of cryoglobulinemia and cryocrit (P > 0.5). The severity of peripheral neuropathy significantly correlated with the duration of HCV infection (P < 0.05). Laser-evoked potential amplitudes were significantly lower in patients with than in those without neuropathic pain (P < 0.05). Conversely, no difference was found in nerve conduction study and skin biopsy findings (P > 0.05). Our findings show that peripheral neuropathy is related to age and HCV infection, rather than to cryoglobulinemia, and neuropathic pain is associated with damage to nociceptive pathways as assessed with laser-evoked potentials; this might be useful for designing more effective clinical interventions for these common HCV related-cryoglobulinemia complications.