Hirai A, Yasuda H, Joko M, Maeda T, Kikkawa R
Third Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
J Neurol Sci. 2000 Jan 1;172(1):55-62. doi: 10.1016/s0022-510x(99)00290-7.
The significance and usefulness of immunohistochemically quantitated cutaneous nerves in the evaluation of diabetic neuropathy was examined in biopsied skins of the calf from healthy subjects (n=12) and non-insulin dependent diabetic patients (n=32) with diabetic sensory neuropathy. Skin samples were immunostained with antibodies against protein gene product (PGP) 9.5, a pan-axonal marker. A quantitative analysis to determine nerve fiber (NF) number and nerve lengths (NLs) was performed on nerve fibers of the epidermis and the dermis and on nerves surrounding sweat glands. Nerve function tests were performed on the biopsied sites and erythrocyte aldose reductase level was determined by enzyme-linked immunosorbent assay. Numbers of epidermal NFs, NLs of epidermis and dermis and NL around sweat glands were significantly decreased in diabetic patients compared with control subjects (P<0.001, P<0.001, P<0.01, P<0.01, respectively). NL of epidermis showed a significant correlation with NL of dermis (P<0.01). Sural nerve conduction velocity was significantly correlated with NL of dermis (P10.8 (average in 555 diabetic patients) ng/mgHb) possessed a shorter NL of dermis NFs than those with lower AR level (<10.8) (P<0.05). These findings suggest that the quantitation of cutaneous nerves in biopsied skin samples provides important information about diabetic neuropathy and may improve the understanding of the pathophysiology of sensory nerve terminals in diabetic neuropathy.
在患有糖尿病感觉神经病变的健康受试者（n = 12）和非胰岛素依赖型糖尿病患者（n = 32）小腿活检皮肤中，研究了免疫组织化学定量皮肤神经在评估糖尿病神经病变中的意义和实用性。皮肤样本用针对泛轴突标记物蛋白基因产物（PGP）9.5的抗体进行免疫染色。对表皮、真皮的神经纤维以及汗腺周围神经进行神经纤维数量和神经长度（NLs）的定量分析。在活检部位进行神经功能测试，并通过酶联免疫吸附测定法测定红细胞醛糖还原酶水平。与对照组相比，糖尿病患者的表皮神经纤维数量、表皮和真皮的神经长度以及汗腺周围的神经长度均显著降低（分别为P < 0.001、P < 0.001、P < 0.01、P < 0.01）。表皮的神经长度与真皮的神经长度呈显著相关性（P < 0.01）。腓肠神经传导速度与真皮的神经长度显著相关（P10.8（555例糖尿病患者的平均值）ng/mgHb）的患者，其真皮神经纤维的神经长度比醛糖还原酶水平较低（<10.8）的患者短（P < 0.05）。这些发现表明，对活检皮肤样本中的皮肤神经进行定量可为糖尿病神经病变提供重要信息，并可能增进对糖尿病神经病变中感觉神经末梢病理生理学的理解。
