Zambelis Thomas, Karandreas Nikos, Tzavellas Elias, Kokotis Panagiotis, Liappas John
EMG Laboratory, Department of Neurology, University of Athens, Aeginition Hospital, Athens, Greece.
J Peripher Nerv Syst. 2005 Dec;10(4):375-81. doi: 10.1111/j.1085-9489.2005.00050.x.
The aim of the present study was to evaluate the occurrence of large and small fiber neuropathy among alcohol-dependent subjects and to correlate neuropathy with the pattern of alcohol abuse, age of the subjects, nutritional status, and biochemical parameters. The study sample comprised 98 consecutive alcohol-dependent subjects without signs of malnutrition treated for detoxification voluntarily in the specialized unit of the Athens University Psychiatric Clinic in an inpatient basis. Polyneuropathy (PN) was graded using the neuropathy symptoms score and neurologic disability score, conduction velocity studies, and quantitative sensory tests. Seventy-seven men and 21 women aged 27-70 years took part in the study. PN was diagnosed in 57 subjects (58.2%). PN of both large and small fibers was found in 25 patients (25.5%); exclusively small fiber neuropathy was observed in 12 (12.2%) and exclusively large fiber neuropathy in 20 patients (20.4%). Neuropathy was significantly correlated with the age of the subjects, duration of alcohol abuse, liver dysfunction, macrocytosis, and blood sugar levels upon admission. PN was significantly more frequent in males than in females. The two groups of exclusively large and exclusively small fiber neuropathy did not differ significantly in any clinical and laboratory parameter. Subclinical neuropathy (stage 1) was observed in 11.2%, which also did not differ significantly in any clinical and laboratory parameter from the stage 2 PN group subjects. Our findings indicate the direct toxic effect of alcohol on peripheral nerve fibers as the main etiologic factor of alcoholic PN. Long-standing hyperglycemia may be another contributing factor. Impaired vitamin B(12) utilization may be also involved.
本研究的目的是评估酒精依赖者中大小纤维神经病变的发生率，并将神经病变与酒精滥用模式、受试者年龄、营养状况和生化参数相关联。研究样本包括98例连续的酒精依赖者，他们在雅典大学精神病诊所的专门科室自愿接受住院戒毒治疗，且无营养不良迹象。使用神经病变症状评分、神经功能障碍评分、传导速度研究和定量感觉测试对多发性神经病变（PN）进行分级。77名男性和21名女性，年龄在27至70岁之间，参与了该研究。57名受试者（58.2%）被诊断为PN。25例患者（25.5%）发现大小纤维均受累的PN；12例（12.2%）仅观察到小纤维神经病变，20例患者（20.4%）仅观察到大纤维神经病变。神经病变与受试者年龄、酒精滥用持续时间、肝功能障碍、大细胞性贫血和入院时血糖水平显著相关。男性PN的发生率显著高于女性。仅大纤维神经病变组和仅小纤维神经病变组在任何临床和实验室参数上均无显著差异。11.2%的患者观察到亚临床神经病变（1期），其在任何临床和实验室参数上与2期PN组受试者也无显著差异。我们的研究结果表明，酒精对周围神经纤维的直接毒性作用是酒精性PN的主要病因。长期高血糖可能是另一个促成因素。维生素B12利用受损也可能参与其中。
