The Strelitz Diabetes Institutes, Department of Internal Medicine, and Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia.
Metab Syndr Relat Disord. 2005 Summer;3(2):113-21. doi: 10.1089/met.2005.3.113.
The etiology of sensory neuropathies is often not found. We tested the hypothesis that the metabolic syndrome (MS) may be associated with painful neuropathy, in the absence of frank diabetes.
Clinical and quantitative neuropathy assessments were performed on 10 neuropathy patients with MS, 20 with MS with type 2 diabetes (10 recent onset and 10 of >5 years in duration), and 10 healthy, age-matched subjects. Intraepidermal nerve fiber density (IENF) and mean dendrite length (MDL) were determined by quantitative immunofluorescence on skin biopsies using antibody to PGP 9.5.
In metabolic syndrome, MDL was reduced and correlated negatively with sensory symptoms, signs, HDL-C, and sural nerve amplitude. The strongest inverse metabolic correlate of the metabolic syndrome neuropathy was HDL-C, which also correlated negatively with sensory symptoms, signs, and sural nerve amplitudes. The strongest metabolic correlate of diabetic sensorimotor neuropathy was HbA1c, which was associated with reduced IENF in patients with >5 years in duration of disease as well as reduced peroneal nerve amplitudes.
These data indicate that metabolic features, including HDL-C in metabolic syndrome, are associated with small fiber neuropathy and that MDL is an early marker of sensory neuropathy in patients with MS. Reductions in IENF reflect a longer duration of diabetes, with hyperglycemia leading to a sensorimotor neuropathy. These findings support the possibility that there is a sensory neuropathy with reduced intraepidermal nerve fiber length, which cosegregates with features of metabolic syndrome.
感觉神经病变的病因通常无法找到。我们检验了这样一个假设，即代谢综合征（MS）可能与无明显糖尿病的痛性神经病相关。
对 10 例 MS 伴痛性神经病患者、20 例 MS 合并 2 型糖尿病（其中 10 例发病时间<5 年，10 例发病时间>5 年）以及 10 例健康、年龄匹配的对照者进行了临床和定量神经病学评估。通过对皮肤活检进行 PGP 9.5 抗体的定量免疫荧光检测，测定表皮内神经纤维密度（IENF）和平均树突长度（MDL）。
在代谢综合征中，MDL 降低，与感觉症状、体征、HDL-C 和腓肠神经振幅呈负相关。代谢综合征神经病的最强负相关代谢指标是 HDL-C，其与感觉症状、体征和腓肠神经振幅也呈负相关。糖尿病感觉运动神经病的最强代谢相关因素是 HbA1c，其与病程>5 年的患者 IENF 减少以及腓总神经振幅降低有关。
这些数据表明，代谢特征（包括代谢综合征中的 HDL-C）与小纤维神经病相关，并且 MDL 是 MS 患者感觉神经病的早期标志物。IENF 的减少反映了糖尿病病程较长，高血糖导致感觉运动神经病。这些发现支持这样一种可能性，即存在一种感觉神经病，其特征是表皮内神经纤维长度减少，与代谢综合征的特征相关。
