Angus-Leppan H, Burke D
Department of Clinical Neurophysiology, Prince Henry Hospital, University of New South Wales, Sydney, Australia.
Muscle Nerve. 1992 Mar;15(3):288-94. doi: 10.1002/mus.880150306.
Previous clinical and neurophysiological studies of uremic neuropathy have focused almost exclusively on the function of large sensory and motor axons. The sensations of heat and cold depend on the function of unmyelinated afferents and small myelinated afferents, respectively, and these sensations can be quantified using a standardized psychophysical technique. Thermal thresholds were measured in 20 patients with end-stage renal failure to determine the extent of small afferent fiber involvement and to compare this with the clinical and electrophysiological evidence of large fiber involvement. Whereas abnormalities of standard nerve conduction studies were found in 16 patients, abnormal thermal thresholds were found in only 6 patients. In the nerve conduction studies, the amplitudes of nerve potentials were reduced more than their conduction velocities, consistent with an axonopathy. This study found little evidence of significant dysfunction of small afferent fibers in end-stage renal failure and, when such changes occurred, they did not correlate with the clinical evidence of polyneuropathy. The functional sparing of axons of small diameter is consistent with the relative sparing of these axons in pathological studies.
先前关于尿毒症神经病变的临床和神经生理学研究几乎完全集中在大型感觉和运动轴突的功能上。热觉和冷觉分别取决于无髓传入神经和小型有髓传入神经的功能，并且这些感觉可以使用标准化的心理物理学技术进行量化。对20例终末期肾衰竭患者测量了热阈值，以确定小型传入纤维受累的程度，并将其与大型纤维受累的临床和电生理证据进行比较。虽然在16例患者中发现了标准神经传导研究异常，但仅在6例患者中发现了异常热阈值。在神经传导研究中，神经电位的幅度比其传导速度降低得更多，这与轴索性神经病一致。本研究几乎没有发现终末期肾衰竭中小型传入纤维存在明显功能障碍的证据，并且当出现此类变化时，它们与多发性神经病的临床证据无关。小直径轴突的功能保留与病理研究中这些轴突的相对保留一致。
