The relationship of nerve fibre pathology to sensory function in entrapment neuropathy.
The relationship of nerve fibre pathology to sensory function in entrapment neuropathy.
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DOI：
10.1093/brain/awu288
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Bennett DL
中科院分区：
文献类型：
--
作者：
Schmid AB;Bland JD;Bhat MA;Bennett DL
周围卡压性神经病对靶神经支配的影响尚不清楚。施密德等人利用定量感觉测试、神经生理学和皮肤活检。结果表明，腕管综合征影响大纤维及其结节复合体，但也与小感觉神经轴突的数量和功能减少有关。令人惊讶的是，关于卡压性神经病对靶神经支配的影响，以及神经纤维病理与感觉症状和体征的关系，人们知之甚少。腕管综合征是最常见的嵌顿性神经病，本研究旨在探讨腕管综合征对无髓和有髓小感觉神经轴突形态的影响及其与躯体感觉功能和临床症状的关系。30例临床和电生理诊断为腕管综合征的患者[女性17例，平均年龄(标准差)56.4(15.3)]和26例年龄和性别匹配的健康志愿者[女性18例，平均年龄(标准差)51.0(17.3)]参与研究。对手部正中神经区域的大小纤维功能进行定量感觉测试。腕管综合征患者(P<；0.007)的振动和机械检测阈值显著升高，证实存在较大的纤维功能障碍，同时患者的热检测阈值(P<；0.0001)也增加，表明C和Aδ-纤维功能障碍。不同组间的机械痛阈值和热痛阈值相似(P&gT；0.13)。取食指近节指骨正中神经支配区域进行皮肤活检。用蛋白基因产物9.5和髓鞘碱性蛋白免疫组织化学染色评价无髓轴突和有髓轴突的形态特征。对表皮内神经纤维密度的评估显示，患者的表皮内神经纤维密度显著下降(P<；0.0001)，证实了小纤维的显著折衷。触觉小体和真皮神经束的范围在两组之间具有可比性(P&gT；0.07)。然而，患者表现出延长结节的百分比显著增加(P<；0.0001)，改变了电压门控钠通道分布的结构。虽然神经生理学或定量感觉测试都与患者的症状或功能缺陷无关，但细长结节的存在与许多与功能和症状相关的分数呈负相关(P<；0.023)。我们的研究结果表明，腕管综合征不仅影响大纤维，而且与无髓和有髓感觉神经轴突共同介导的功能丧失有关。我们还首次证明，卡压性神经病导致表皮内神经纤维密度明显降低，这与电诊断测试的严重程度无关。靶组织中细长结节的存在进一步表明，卡压性神经病对结节结构/髓鞘的影响远远超出了局灶性压迫部位。有趣的是，结节延长可能是一种适应性现象，因为它与症状严重程度呈负相关。
The impact of peripheral entrapment neuropathies on target innervation remains unknown. Using quantitative sensory testing, neurophysiology and skin biopsies, Schmid et al. demonstrate that carpal tunnel syndrome affects large fibres and their nodal complexes, but is also associated with a reduction in the number and functioning of small sensory axons. Surprisingly little is known about the impact of entrapment neuropathy on target innervation and the relationship of nerve fibre pathology to sensory symptoms and signs. Carpal tunnel syndrome is the most common entrapment neuropathy; the aim of this study was to investigate its effect on the morphology of small unmyelinated as well as myelinated sensory axons and relate such changes to somatosensory function and clinical symptoms. Thirty patients with a clinical and electrophysiological diagnosis of carpal tunnel syndrome [17 females, mean age (standard deviation) 56.4 (15.3)] and 26 age and gender matched healthy volunteers [18 females, mean age (standard deviation) 51.0 (17.3)] participated in the study. Small and large fibre function was examined with quantitative sensory testing in the median nerve territory of the hand. Vibration and mechanical detection thresholds were significantly elevated in patients with carpal tunnel syndrome (P < 0.007) confirming large fibre dysfunction and patients also presented with increased thermal detection thresholds (P < 0.0001) indicative of C and Aδ-fibre dysfunction. Mechanical and thermal pain thresholds were comparable between groups (P > 0.13). A skin biopsy was taken from a median nerve innervated area of the proximal phalanx of the index finger. Immunohistochemical staining for protein gene product 9.5 and myelin basic protein was used to evaluate morphological features of unmyelinated and myelinated axons. Evaluation of intraepidermal nerve fibre density showed a striking loss in patients (P < 0.0001) confirming a significant compromise of small fibres. The extent of Meissner corpuscles and dermal nerve bundles were comparable between groups (P > 0.07). However, patients displayed a significant increase in the percentage of elongated nodes (P < 0.0001), with altered architecture of voltage-gated sodium channel distribution. Whereas neither neurophysiology nor quantitative sensory testing correlated with patients’ symptoms or function deficits, the presence of elongated nodes was inversely correlated with a number of functional and symptom related scores (P < 0.023). Our findings suggest that carpal tunnel syndrome does not exclusively affect large fibres but is associated with loss of function in modalities mediated by both unmyelinated and myelinated sensory axons. We also document for the first time that entrapment neuropathies lead to a clear reduction in intraepidermal nerve fibre density, which was independent of electrodiagnostic test severity. The presence of elongated nodes in the target tissue further suggests that entrapment neuropathies affect nodal structure/myelin well beyond the focal compression site. Interestingly, nodal lengthening may be an adaptive phenomenon as it inversely correlates with symptom severity.
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DOI：
10.1111/j.1748-1716.1989.tb08634.x
发表时间：
1989-05-01
期刊：
ACTA PHYSIOLOGICA SCANDINAVICA
影响因子：
--
作者：
DAHLIN, LB;SHYU, BC;ANDERSSON, SA
通讯作者：
ANDERSSON, SA
影响因子：
4.8
作者：
Bastien, Celyne H.;Vallieres, Annie;Morin, Charles M.
通讯作者：
Morin, Charles M.
影响因子：
14.5
作者：
Cappelen-Smith, C;Lin, CSY;Burke, D
通讯作者：
Burke, D
DOI：
10.2106/00004623-198163030-00009
发表时间：
1981-01-01
影响因子：
5.3
作者：
GELBERMAN, RH;HERGENROEDER, PT;AKESON, WH
通讯作者：
AKESON, WH
影响因子：
3.8
作者：
Doppler, Kathrin;Werner, Christian;Sommer, Claudia
通讯作者：
Sommer, Claudia