Herrmann David N, Boger J Neil, Jansen Cortney, Alessi-Fox Christi
Department of Neurology, Box 673, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA.
Neurology. 2007 Dec 4;69(23):2121-7. doi: 10.1212/01.wnl.0000282762.34274.94. Epub 2007 Sep 26.
To assess feasibility of noninvasive in vivo reflectance confocal microscopy (RCM) of Meissner corpuscles (MCs) as a measure of sensory neuropathy (SN).
MCs are touch-pressure sensation receptors in glabrous skin. Skin biopsy studies suggest that fingertip MC density (MCs/mm(2)) is a sensitive measure of diabetic and idiopathic SN. In vivo RCM of skin is an emerging field, with applications including evaluation of cancer. It is painless and noninvasive. Feasibility of in vivo RCM of MCs has not been explored.
Fifteen adults (10 controls, 5 SN subjects) underwent in vivo RCM at the fingertip (Digit V) and thenar eminence. In vivo RCM was conducted to determine whether MCs were visible within dermal papillae and, if visible, to characterize their imaging appearance and assess MCs/mm(2) at each site.
MCs were identified in dermal papillae at all sites in controls. MCs appeared as heterogeneous bright structures within dermal papillae, which appeared as dark "pits." Mean MC density in controls was 12 +/- 5.3/mm(2) (Digit V) and 5.1 +/- 2.2/mm(2) at the thenar eminence. MC density in SN was lower than controls at Digit V (2.8 +/- 5.7/mm(2), p = 0.01) and the thenar eminence (1.4 +/- 1.1/mm(2), p = 0.004). MCs were absent in a sensory neuronopathy; milder reductions in MC density were seen among diabetic and HIV-positive subjects.
Meissner corpuscles (MCs) can be visualized and quantitated in controls and sensory neuropathy (SN) using in vivo reflectance confocal microscopy (RCM). In vivo RCM of MCs has potential for noninvasive detection and monitoring of SN, if subsequent studies show that with denervation or reinnervation, reliable and recognizable changes or loss can be detected using our described approaches.
评估采用体内反射式共聚焦显微镜（RCM）对迈斯纳小体（MCs）进行无创检测作为感觉神经病变（SN）一项指标的可行性。
MCs是无毛皮肤中的触觉压力感受器。皮肤活检研究表明，指尖MC密度（个/mm²）是糖尿病性和特发性SN的一项敏感指标。皮肤的体内RCM是一个新兴领域，其应用包括癌症评估。它无痛且无创。MCs的体内RCM可行性尚未得到探索。
15名成年人（10名对照者，5名SN受试者）在指尖（第五指）和鱼际隆起处接受了体内RCM检查。进行体内RCM以确定真皮乳头内是否可见MCs，若可见，则对其成像外观进行特征描述，并评估每个部位的MCs/mm²。
在对照者的所有部位真皮乳头中均识别出MCs。MCs在真皮乳头内表现为异质性明亮结构，真皮乳头表现为深色“凹坑”。对照者中，第五指的平均MC密度为12±5.3个/mm²，鱼际隆起处为5.1±2.2个/mm²。SN患者第五指（2.8±5.7个/mm²，p = 0.01）和鱼际隆起处（1.4±1.1个/mm²，p = 0.004）的MC密度低于对照者。在感觉神经元病中MCs缺失；在糖尿病患者和HIV阳性受试者中，MC密度降低程度较轻。
使用体内反射式共聚焦显微镜（RCM）可在对照者和感觉神经病变（SN）中观察并定量迈斯纳小体（MCs）。如果后续研究表明，通过去神经支配或再支配，使用我们所描述的方法能够检测到可靠且可识别的变化或缺失，那么MCs的体内RCM在SN的无创检测和监测方面具有潜力。
