Fuller G N, Jacobs J M, Guiloff R J
Department of Neuropathology, Institute of Neurology, London, Great Britain.
Acta Neuropathol. 1990;81(2):198-203. doi: 10.1007/BF00334508.
We compared the sural nerves from patients with AIDS; four with the painful peripheral neuropathy (PPN), three patients with non-painful distal symmetrical peripheral neuropathy (DSPN), one without clinical peripheral nerve involvement and two human immunodeficiency virus negative controls. Fibre diameter distributions showed a slight reduction in larger fibres in all patients with AIDS compared with controls. No significant difference was found in the relative frequency distribution of the lamellae counts between any of the groups. The relative frequency distribution of axonal area of myelinated fibres did not differ between controls, non-painful DSPN or the patient without peripheral nerve involvement; however, all patients with PPN showed marked reduction in the number of axons of myelinated fibres of larger area which was significant when compared to each patient from the other groups (P less than 0.0001). This indicates that the reduction in larger fibres in PPN is mostly due to axonal atrophy rather than selective fibre loss. Axonal atrophy is associated with painful peripheral neuropathy in AIDS but not with those without pain. The possible role of axonal atrophy as a pathological substrate for pain is discussed.
我们比较了艾滋病患者的腓肠神经；4例患有疼痛性周围神经病变（PPN），3例患有非疼痛性远端对称性周围神经病变（DSPN），1例无临床周围神经受累，以及2例人类免疫缺陷病毒阴性对照。纤维直径分布显示，与对照组相比，所有艾滋病患者中较大纤维略有减少。在任何组之间，板层计数的相对频率分布均未发现显著差异。有髓纤维轴突面积的相对频率分布在对照组、非疼痛性DSPN或无周围神经受累的患者之间没有差异；然而，所有PPN患者中较大面积有髓纤维的轴突数量均显著减少，与其他组的每位患者相比有显著差异（P小于0.0001）。这表明PPN中较大纤维的减少主要是由于轴突萎缩而非选择性纤维丢失。轴突萎缩与艾滋病中的疼痛性周围神经病变相关，但与无疼痛的病变无关。讨论了轴突萎缩作为疼痛病理基础的可能作用。
