CORRELATION OF QUANTITATIVE SUDOMOTOR AXON REFLEX TESTING

我们建议研究QSART与穿孔皮肤活检确定的小纤维神经病变病理证实之间的相关性。我们建议研究10例非糖尿病小纤维神经病变患者，10例糖尿病神经病变患者（活检部位QSART异常），10例其他主要大纤维神经病变患者，如慢性炎症性神经病变（其中QSART可能正常），作为自主反射实验室自主反射筛查的一部分，进行QSART检测。我们还建议研究10名正常对照，作为实验方案的一部分，将对其进行QSART测试。患者和对照组将在QSART测试的部位（腓骨头以下5厘米的腿近端和踝关节内踝以上5厘米的腿远端）进行两次直径4毫米的穿孔皮肤活检。手术将以无菌方式进行。用无菌胶条和敷料包扎皮肤。皮肤活检将放置于固定液中，进行组织病理学和免疫细胞化学检查。后者包括将活检材料送到约翰霍普金斯医院的周围神经实验室进行专门的染色和神经纤维密度定量。去甲肾上腺素含量的组织水平，使用微孔高效液相色谱法，将在刘博士的实验室进行。活检和标本处理将采用通用预防措施，以尽量减少任何污染风险。

We propose to study the correlation between QSART and pathological confirmation of small fiber neuropathy as determined by punch skin biopsy. We propose to study 10 patients with non diabetic small fiber neuropathy, 10 patients with diabetic neuropathy (with abnormal QSART over the biopsy site), and 10 patients with other, predominantly large fiber neuropathies such as chronic inflammatory dymelinating neuropathy (in whom QSART is likely to be normal) referred for QSART testing as part of an Autonomic Reflex Screen in the Autonomic Reflex Laboratory. We also propose to study 10 normal controls on whom QSART testing will be performed as part of the experimental protocol. Patients and controls will have two 4 mm diameter punch skin biopsies performed at sites of QSART testing (proximal leg 5 cms below the fibular head and distal leg 5 cm above the medial malleolus of the ankle). The procedure will be performed in a sterile fashion. The skin will be closed with a sterile adhesive strip and a dressing applied. The skin biopsy will be placed in fixative and processed for histopathological and immunocytochemical examination. The latter will involve sending biopsy material to the peripheral nerve laboratory at Johns Hopkins Hospital for specialized staining and quantitation of nerve fiber density. Tissue levels of norepinephrine content, using microbore HPLC, will be performed in Dr. Low's laboratory. Biopsy and handling of the specimen will be carried out using universal precautions to minimize any contamination risk.