Department of Neurology, Hospital Clínic, Barcelona, Spain IDIBAPS (Institut d'Investigació Augustí Pi i Sunyer), University of Barcelona, Barcelona, Spain Department of Internal Medicine, Hospital Clínic, Barcelona, Spain.
Pain. 2011 Feb;152(2):410-418. doi: 10.1016/j.pain.2010.11.012. Epub 2010 Dec 24.
This study analyzed the relationship between the density of intraepidermal nerve fibers (IENF) and the characteristics of either nociceptive laser-evoked potentials (LEPs) or contact heat-evoked potentials (CHEPs) in patients with painful sensory polyneuropathy with the aim to determine which parameters of LEPs and CHEPs more reliably reflect IENF loss. A total of 96 patients and 35 healthy volunteers took part in the study. Based on clinical examination, nerve conduction tests, and quantitative sensory testing, we identified 52 patients with small-fiber neuropathy (SFN), 40 with mixed (small-fiber and large-fiber) neuropathy (MFN), and 4 who were excluded from the analysis because of no evidence of involvement of small fibers. The latency of the N2 was delayed for both LEPs and CHEPs in patients with MFN and for CHEPs only in patients with SFN. The amplitude of the vertex N2/P2 potential was similarly reduced in both types of neuropathy, but LEPs were more frequently absent than CHEPs in MFN patients (68% vs 40%). In general, latency and amplitude of LEPs and CHEPs were well correlated with IENF density. SFN patients were characterized by abnormal EPs and slightly decreased but morphologically abnormal IENF. MFN patients were characterized by frequently absent LEPs and CHEPs and a rather severe IENF loss. The correlation between nociceptive evoked potentials (laser-evoked potentials and contact heat-evoked potentials) and skin biopsy aids in the diagnosis of painful neuropathies.
本研究分析了痛觉性激光诱发电位（LEP）和接触热诱发电位（CHEP）的特征与感觉性多发性神经病患者表皮内神经纤维密度（IENF）之间的关系，旨在确定 LEP 和 CHEP 的哪些参数更能可靠地反映 IENF 缺失。共有 96 名患者和 35 名健康志愿者参与了这项研究。根据临床检查、神经传导测试和定量感觉测试，我们确定了 52 名小纤维神经病（SFN）患者、40 名混合性（小纤维和大纤维）神经病（MFN）患者和 4 名因无小纤维受累证据而被排除分析的患者。LEP 和 CHEP 在 MFN 患者中 N2 潜伏期延迟，而仅在 SFN 患者中 CHEP 潜伏期延迟。两种神经病变患者的顶点 N2/P2 电位振幅均明显降低，但 MFN 患者的 LEP 比 CHEP 更常缺失（68%对 40%）。一般来说，LEP 和 CHEP 的潜伏期和振幅与 IENF 密度密切相关。SFN 患者的特点是异常的 EP 和略有减少但形态异常的 IENF。MFN 患者的特点是 LEP 和 CHEP 经常缺失和相当严重的 IENF 丢失。痛觉诱发电位（激光诱发电位和接触热诱发电位）和皮肤活检的相关性有助于疼痛性神经病的诊断。
