Herrmann David N
Peripheral Neuropathy Clinic and Cutaneous Innervation Laboratory, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY 14642-8673, USA.
Expert Rev Neurother. 2008 Dec;8(12):1807-16. doi: 10.1586/14737175.8.12.1807.
Peripheral neuropathies are diverse and require a multidimensional approach for detection and monitoring in a clinical and research setting. This review describes non- and minimally-invasive measures of distal predominantly sensory polyneuropathy (DSP), the most common form of neuropathy. A combination of clinical and electrophysiologic assessment with nerve-conduction studies (NCSs) suffices for the detection and characterization of most DSPs. NCS are insensitive to variants of DSP that predominantly affect small diameter sensory nerve fibers (SFNs) and cutaneous nerve terminals that subserve pain and thermal sensation. Skin biopsy with assessment of epidermal nerve fiber density permits objective detection and monitoring of SFNs. Conventional clinical and NCS measures have limitations as outcomes in experimental therapeutics in DSP. For clinical trials, biopsy evaluation of epidermal innervation and emerging noninvasive imaging approaches (in vivo confocal microscopy of corneal innervation and of Meissner corpuscles in the skin) hold promise as surrogate markers that are complementary to traditional DSP measures.
周围神经病变多种多样，在临床和研究环境中进行检测和监测需要采用多维度方法。本综述描述了以远端为主的感觉性多发性神经病变（DSP）的非侵入性和微创性检测方法，DSP是最常见的神经病变形式。临床评估和神经传导研究（NCS）相结合的电生理评估足以检测和表征大多数DSP。NCS对主要影响小直径感觉神经纤维（SFN）和负责疼痛及热感觉的皮肤神经末梢的DSP变体不敏感。通过评估表皮神经纤维密度进行皮肤活检可客观检测和监测SFN。传统的临床和NCS测量方法在DSP实验治疗中作为结果存在局限性。对于临床试验，表皮神经支配的活检评估和新兴的非侵入性成像方法（角膜神经支配和皮肤中迈斯纳小体的体内共聚焦显微镜检查）有望作为替代标志物，补充传统的DSP测量方法。
