Painful sensory neuropathy - Prospective evaluation using skin biopsy
Painful sensory neuropathy - Prospective evaluation using skin biopsy
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DOI：
10.1212/wnl.53.8.1641
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发表时间：
1999-11-10
期刊：
影响因子：
9.9
通讯作者：
Mendell, JR
中科院分区：
文献类型：
--
作者：
Periquet, MI;Novak, V;Mendell, JR
目的：在出现足部疼痛、灼热并有轻微神经病变迹象的患者中，我们解决了以下问题：1)这些患者中有多少人有周围神经病变？2)皮肤活检在确定神经病变的诊断中起什么作用？3)什么情况与神经病变有关？以及4)哪些实验室研究对这些患者群体有用？方法：对117例连续入选的患者进行前瞻性研究。所有人都接受了神经传导研究(NCS)和一系列血液测试，包括抗神经抗体。如果NCS正常，则对小腿远端皮肤进行穿孔活组织检查，以确定表皮内神经纤维(IENF)密度。在32例患者中，皮肤活检的敏感性与定量运动轴突试验(QSART)和定量感觉试验(QST)进行了比较。结果：共分成三组。NCS异常组(n=60，34女/26M，平均年龄60±14岁)，占队列的51%。大多数人有不明原因的神经病，但18人(30%)有相关疾病。第2组NCS正常，IENF密度降低(n=44，29女/15M，平均年龄57±14岁)，占队列的38%。这组人中有三人有相关疾病。第3组，NCS和IENF密度正常(n=13，6 F/7 M，平均年龄53+/-13岁)，占队列的11%；大多数没有诊断，但2例有MS。在比较亚组分析中，皮肤活检在诊断神经病变方面比QSART或QST更敏感。结论：表现为足部疼痛的患者是异质性的，既有大纤维感觉神经病，也有小纤维感觉神经病。在极少数情况下，可以找到疼痛的主要原因。超过三分之一的患者需要皮肤活检来诊断细小纤维感觉神经病。一组有限的血液测试有助于诊断，但血清抗病毒抗体无济于事。
Objective: In patients presenting with painful, burning feet with minimal signs of neuropathy, the following questions were addressed: 1) How many of these patients have a peripheral neuropathy? 2) What is the role of skin biopsy in establishing a diagnosis of neuropathy? 3) What conditions are associated with the neuropathy? and 4) What laboratory studies are useful in this patient population? Methods: A total of 117 consecutive patients referred for evaluation:were prospectively studied. All underwent nerve conduction studies (NCS) and a battery of blood tests, including antinerve antibodies. If NCS were normal, a punch biopsy of the skin of the distal leg was performed to ascertain the intraepidermal nerve fiber (IENF) density. In a subset of 32 patients, the sensitivity of skin biopsy was compared to quantitative sudomotor axon test (QSART) and quantitative sensory tests (QST). Results: Three groups emerged. Group 1, with abnormal NCS (n = 60, 34 F/26 M, mean age 60 +/- 14 years), represented 51% of the cohort. The majority had neuropathies of undetermined cause, but 18 (30%) had associated conditions. Group 2, with normal NCS and reduced IENF density (n = 44, 29 F/15 M, mean age 57 +/- 14 years), represented 38% of the cohort. Three in this group had associated conditions. Group 3, with normal NCS and IENF density (n = 13, 6 F/7 M, mean age 53 +/- 13 years), represented 11% of the cohort; most had no diagnoses but two had MS. In a comparative subset analysis, skin biopsy was more sensitive than QSART or QST in diagnosing a neuropathy. Conclusions: Patients presenting with painful feet are heterogeneous, consisting of both large and small fiber sensory neuropathies. In rare cases, a central cause for pain can be found. Over one-third of patients required a skin biopsy to diagnose a small fiber sensory neuropathy. A limited battery of blood tests facilitated diagnosis, but serum antinerve antibodies were not helpful.