Properties of cutaneous afferents in diabetic neuropathy.
Properties of cutaneous afferents in diabetic neuropathy.
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糖尿病神经病变中皮肤传入的特性。
DOI：
10.1093/brain/112.5.1359
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Mackel,R
中科院分区：
文献类型：
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作者：
Mackel,R
应用经皮神经显微摄影技术对8例糖尿病患者的68条皮肤传入神经的反应特性进行了研究，并与12例正常对照者的104条皮肤传入神经进行了比较。糖尿病患者神经系统无症状或有轻度感觉神经病变。在糖尿病受试者中研究了机械皮肤刺激的三种传入类型（快速适应型RA和缓慢适应SAI和SAII），所有类型的神经纤维都出现异常反应，大约30%的RA和20%的SAI型神经纤维出现明显异常。异常包括对阈值以上刺激仅产生单一动作电位（RA）和对重复刺激的高疲劳性（SAI）。在适应缓慢的SAI组和SAII组中还会遇到更细微的异常。这包括低放电率和持续的皮肤压痕，与正常值有统计学上的显著差异。绝对机械反应阈值和感受野配置在糖尿病和正常单位之间相似。在皮内电刺激下测量单个神经纤维的传导速度，无论传入神经对感受野的生理刺激是否表现出正常或异常的反应，它们的传导速度与正常相似。数据表明，不同的皮肤传入类型受到疾病的影响，其传递动作电位序列的能力受到限制，因此，生理刺激可能在糖尿病单位中被异常编码。这些结果为理解糖尿病性神经病变的神经纤维功能障碍和感觉障碍提供了生理学基础
The technique of percutaneous microneurography was used to study the response properties of 68 cutaneous afferents in 8 diabetic patients and, for comparison, of 104 afferents in 12 normal control subjects. The diabetic patients were neurologically asymptomatic or had a mild sensory neuropathy. Three afferent categories were studied in the diabetic subjects (rapidly adapting type RA and slowly adapting SAI and SAII) in response to mechanical skin stimulation and abnormal responsiveness was encountered in all categories Distinct abnormalities were seen in about 30% of the RA and in 20% of the SAI type nerve fibres. The abnormalities consisted of the generation of only single action potentials to above threshold stimuli (RA), and of high fatiguability to repetitive stimulation (SAI). A more subtle abnormality was additionally encountered in the slowly adapting SAI and SAII groups. This consisted of low discharge rates to sustained skin indentation, with values statistically significantly different from normal. Absolute mechanical response thresholds and receptive field configurations were similar between diabetic and normal units.The conduction velocities of individual nerve fibres were measured in response to intradermal electrical stimulation They were similar to normal, regardless of whether the afferents displayed normal or abnormal responsiveness to physiological stimulation of the receptive fields.The data indicate that different cutaneous afferent categories are affected by the disease, and are limited in their ability to transmit trains of action potentials As a consequence, physiological stimuli may be abnormally encoded in diabetic units Two hypotheses, one morphological and one biophysical, are proposed for explaining the present findings The results altogether provide a physiological basis for understanding nerve fibre dysfunction and sensory disturbances in human diabetic neuroputhy