Antunes S L G, Chimelli L M, Rabello E T, Valentim V C, Corte-Real S, Sarno E N, Jardim M R
Laboratório de Hanseníase, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Braz J Med Biol Res. 2006 Aug;39(8):1071-81. doi: 10.1590/s0100-879x2006000800010.
The nerve biopsies of 11 patients with pure neuritic leprosy were submitted to routine diagnostic procedures and immunoperoxidase staining with antibodies against axonal (neurofilament, nerve growth factor receptor (NGFr), and protein gene product (PGP) 9.5) and Schwann cell (myelin basic protein, S-100 protein, and NGFr) markers. Two pairs of non-adjacent histological cross-sections of the peripheral nerve were removed for quantification. All the fascicles of the nerve were examined with a 10X-ocular and 40X-objective lens. The immunohistochemistry results were compared to the results of semithin section analysis and clinical and electroneuromyographic data. Neurofilament staining was reduced in 100% of the neuritic biopsies. NGFr positivity was also reduced in 81.8%, PGP staining in 100% of the affected nerves, S100 positivity in 90.9%, and myelin basic protein immunoreactivity in 90.9%. Hypoesthesia was associated with decreased NGFr (81.8%) and PGP staining (90.9%). Reduced potential amplitudes (electroneuromyographic data) were found to be associated with reduced PGP 9.5 (63.6%) and nerve fiber neurofilament staining (45.4%) by immunohistochemistry and with loss of myelinated fibers (100%) by semithin section analysis. On the other hand, the small fibers (immunoreactive dots) seen amid inflammatory cells continued to be present even after 40% of the larger myelinated fibers had disappeared. The present study shows an in-depth view of the destructive effects of leprosy upon the expression of neural markers and the integrity of nerve fiber. The association of these structural changes with the clinical and electroneuromyographic manifestations of leprosy peripheral neuropathy was also discussed.
对11例纯神经炎型麻风患者的神经活检标本进行了常规诊断程序以及使用抗轴突（神经丝、神经生长因子受体（NGFr）和蛋白基因产物（PGP）9.5）和施万细胞（髓磷脂碱性蛋白、S-100蛋白和NGFr）标志物的抗体进行免疫过氧化物酶染色。取两对不相邻的外周神经组织学横切片进行定量分析。用10倍目镜和40倍物镜检查神经的所有束。将免疫组织化学结果与半薄切片分析结果以及临床和神经电生理数据进行比较。在100%的神经炎活检标本中神经丝染色减少。81.8%的标本中NGFr阳性也减少，100%的受累神经中PGP染色减少，90.9%的标本中S100阳性减少，90.9%的标本中髓磷脂碱性蛋白免疫反应性减少。感觉减退与NGFr减少（81.8%）和PGP染色减少（90.9%）相关。通过免疫组织化学发现，电位幅度降低（神经电生理数据）与PGP 9.5减少（63.6%）和神经纤维神经丝染色减少（45.4%）相关，通过半薄切片分析与有髓纤维丢失（100%）相关。另一方面，即使40%的较大有髓纤维消失后，炎症细胞中可见的小纤维（免疫反应性小点）仍持续存在。本研究深入观察了麻风对神经标志物表达和神经纤维完整性的破坏作用。还讨论了这些结构变化与麻风周围神经病变的临床和神经电生理表现之间的关联。
