格林-巴利综合征的无髓鞘和有髓鞘皮肤神经损伤：与疼痛和恢复的相关性。
Unmyelinated and myelinated skin nerve damage in Guillain-Barré syndrome: correlation with pain and recovery.
机构信息
Department of Neurology, Erasmus MC, University of Rotterdam, 's-Gravendijkwal 230, 3015CE Rotterdam, The Netherlands Neuromuscular Diseases Unit, IRCCS Foundation, "Carlo Besta" Neurological Institute, via Celoria, 11, 20133 Milan, Italy Department of Neuroscience, Erasmus MC, University of Rotterdam, 's-Gravendijkwal 230, 3015CE Rotterdam, The Netherlands Department of Psychiatry, Erasmus MC, University of Rotterdam, 's-Gravendijkwal 230, 3015CE Rotterdam, The Netherlands School of Psychology, Mood Disorders Centre Psychology, College of Life and Environmental Sciences, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter EX4 4QG, UK Department of Internal Medicine, Erasmus MC, University of Rotterdam, 's-Gravendijkwal 230, 3015CE Rotterdam, The Netherlands.
出版信息
Pain. 2012 Feb;153(2):399-409. doi: 10.1016/j.pain.2011.10.037. Epub 2011 Dec 10.
We performed a prospective study in 32 patients with Guillain-Barré syndrome (GBS) or its variants to correlate intraepidermal nerve fiber density (IENFD) at the distal leg and lumbar region with pain, autonomic dysfunction, and outcome. In the acute phase, IENFD was reduced in 60% and 61.9% of patients at the distal leg and lumbar region, respectively. In the acute phase, 43.7% of patients complained of neuropathic pain. Their IENFD at the distal leg was significantly lower than in patients without pain (P<.001) and correlated with pain intensity (r(s)=-0.51; P=.003). Intriguingly, also patients with the pure motor variant of GBS and pain had low IENFD. At 6-month follow-up, only 3 patients complained of persisting neuropathic pain, whereas 3 patients reported late-onset pain symptoms. IENFD in the acute phase did not predict presence or intensity of pain at 6-month follow-up. IENFD in the acute phase did not correlate with clinical dysautonomia or GBS severity at nadir. However, it correlated with poorer GBS disability score at 6 months (P=.04), GBS score at nadir (P=.03), and clinically probable dysautonomia (P=.004). At 6-month follow-up, median IENFD remained significantly low both at the distal leg (P=.024) and lumbar region (P=.005). Double and triple staining confocal microscope studies showed diffuse damage of myelinated dermal nerves along with axonal degeneration, and mononuclear cell infiltration. Unmyelinated and myelinated skin nerves are diffusely affected in GBS and its variants, including the pure motor form. IENFD declines early, remains low over time, correlates with pain severity in the acute phase, and may predict long-term disability.
我们对 32 例格林-巴利综合征（GBS）或其变异型患者进行了前瞻性研究，以将小腿和腰部的表皮神经纤维密度（IENFD）与疼痛、自主神经功能障碍和结局相关联。在急性期，小腿和腰部分别有 60%和 61.9%的患者 IENFD 减少。在急性期，43.7%的患者出现神经性疼痛。他们的小腿 IENFD 明显低于无疼痛的患者（P<.001），且与疼痛强度相关（r(s)=-0.51；P=.003）。有趣的是，患有纯运动变异型 GBS 且伴有疼痛的患者也存在 IENFD 降低。在 6 个月的随访中，仅有 3 例患者报告持续存在神经性疼痛，而 3 例患者报告出现迟发性疼痛症状。急性期的 IENFD 不能预测 6 个月随访时疼痛的存在或强度。急性期的 IENFD 与临床自主神经功能障碍或 GBS 严重程度在最低点时无相关性。然而，它与 6 个月时 GBS 残疾评分较差相关（P=.04）、最低点时 GBS 评分相关（P=.03），且与临床可能性自主神经功能障碍相关（P=.004）。在 6 个月的随访中，小腿（P=.024）和腰部（P=.005）的 IENFD 中位数均显著降低。双和三重染色共聚焦显微镜研究显示，有髓真皮神经的弥漫性损伤伴有轴突变性和单核细胞浸润。在 GBS 及其变异型中，包括纯运动型，无髓和有髓皮肤神经均受到广泛影响。IENFD 早期下降，随时间推移持续降低，与急性期疼痛严重程度相关，可能预测长期残疾。
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