Teunissen L L, Veldink J, Notermans N C, Bleys R L A W
Department of Neurology, Rudolf Magnus Institute, University Medical Center Utrecht, G03.236, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Acta Neuropathol. 2002 May;103(5):475-80. doi: 10.1007/s00401-001-0492-6. Epub 2002 Feb 27.
The peripheral nerve is supplied by the vasa nervorum. The epi- and perineurial vessels are innervated by an autonomic plexus, which plays a role in regulation of the endoneurial blood flow. This innervation is decreased in diabetes and alcohol polyneuropathy and seems to precede the development of diabetic polyneuropathy. A decreased innervation may therefore play a role in the development of polyneuropathy. In peripheral arterial disease (PAD) clinical and morphological features are present, related to severity of ischemia. To investigate the innervation of the vasa nervorum in severe ischemia, we performed immunofluorescence staining with the general neural marker protein gene product (PGP) 9.5 in whole mount preparations of epineurial vessels of nine sural nerves taken from patients with legs amputated because of severe PAD (59+/-15 years, mean +/- SD) and ten age-matched controls (61+/-24 years). In patients with PAD the nerve density of the perivascular plexus was decreased in comparison with controls (mean intercept density/mm +/- SD) 26.0+/-6.9 in PAD and 39.9+/-10.7 in controls, area% 6.0+/-1.6 in PAD and 9.9+/-2.6 in controls, both P<0.01, t-test). A decreased perivascular plexus may result in a diminished regulation of the endoneurial blood flow in patients with severe PAD.
周围神经由神经滋养血管供血。神经外膜和神经束膜血管由一个自主神经丛支配，该神经丛在调节神经内膜血流中起作用。在糖尿病和酒精性多发性神经病中，这种神经支配减少，且似乎先于糖尿病性多发性神经病的发生。因此，神经支配减少可能在多发性神经病的发展中起作用。在周围动脉疾病（PAD）中，存在与缺血严重程度相关的临床和形态学特征。为了研究严重缺血时神经滋养血管的神经支配情况，我们对9例因严重PAD行腿部截肢患者（59±15岁，平均±标准差）和10例年龄匹配的对照者（61±24岁）的腓肠神经神经外膜血管整装标本，用通用神经标志物蛋白基因产物（PGP）9.5进行免疫荧光染色。与对照组相比，PAD患者血管周围丛的神经密度降低（平均截距密度/mm±标准差：PAD组为26.0±6.9，对照组为39.9±10.7；面积百分比：PAD组为6.0±1.6，对照组为9.9±2.6，均P<0.01，t检验）。血管周围丛减少可能导致严重PAD患者神经内膜血流调节减弱。
