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患者在接受植物生物碱紫杉醇和长春新碱治疗后存在持续的神经病变。

Persistent chemoneuropathy in patients receiving the plant alkaloids paclitaxel and vincristine.

机构信息

Department of Psychology, York College of Pennsylvania, Appell Life Sciences Building, York, PA 17403, USA.

出版信息

Cancer Chemother Pharmacol. 2013 Mar;71(3):619-26. doi: 10.1007/s00280-012-2047-z. Epub 2012 Dec 11.

DOI:10.1007/s00280-012-2047-z
PMID:23228992
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3581748/
Abstract

PURPOSE

Chemoneuropathy remains a painful, burdensome complication of cancer treatment for patients receiving a range of chemotherapeutics, yet the cause and persistence of this condition are not fully documented. This study was designed to quantify the longevity of and contributions to neuropathy following treatment with the plant alkaloids paclitaxel and vincristine.

METHODS

Quantitative sensory testing was conducted approximately 18 months apart on 14 patients, seven of which had been treated with paclitaxel and seven with vincristine and compared to data from 18 healthy control subjects. In addition, skin biopsies were obtained to investigate changes in the density of Meissner's corpuscles and epidermal nerve fibers (ENFs), the loss of which is thought to contribute to multiple forms of neuropathy.

RESULTS

Impairments in motor skills, as measured by a grooved peg-board, were found. Deficits in touch detection were observed using von Frey monofilaments, as were changes in sharpness detection using a weighted needle device. Using a Peltier device, warmth and heat detection were impaired. These deficits were consistent across time. Remarkably, the average length of time patients reported painful neuropathy was over four and a half years. Skin biopsies were found to be deficient in Meissner's corpuscles and ENFs.

CONCLUSIONS

The combination of widespread deficits in sensory testing and decreases in skin innervation for cancer patients receiving paclitaxel or vincristine document a persistent polyneuropathy which severely impacts these patients. Decreases in Meissner's corpuscles and ENFs indicate a possible mechanism for the neuropathy.

摘要

目的

接受多种化疗药物治疗的癌症患者会出现神经病变，这是一种痛苦且负担沉重的并发症，但这种情况的原因和持续时间尚未完全记录。本研究旨在量化紫杉醇和长春新碱治疗后神经病变的持续时间和发病机制。

方法

对 14 名患者进行了大约 18 个月的定量感觉测试，其中 7 名患者接受了紫杉醇治疗，7 名患者接受了长春新碱治疗，并与 18 名健康对照者的数据进行了比较。此外，还获取皮肤活检样本，以研究梅斯纳小体和表皮神经纤维（ENF）密度的变化，据认为这些变化会导致多种形式的神经病变。

结果

发现运动技能受损，通过使用槽形钉板进行测量。使用冯·弗雷单丝检测到触觉检测缺陷，使用加权针设备检测到锐度检测变化。使用珀耳帖设备，对温暖和热的感知受损。这些缺陷是一致的随着时间的推移。值得注意的是，患者报告疼痛性神经病变的平均时间超过四年半。皮肤活检显示梅斯纳小体和 ENF 缺失。

结论

接受紫杉醇或长春新碱治疗的癌症患者的感觉测试广泛受损和皮肤神经支配减少，证明了一种持续性多发性神经病变，严重影响了这些患者。梅斯纳小体和 ENF 的减少表明神经病变的可能机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/ef94f2c863ec/nihms-428309-f0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/df33962e90e9/nihms-428309-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/e216aeef4268/nihms-428309-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/01c376fceb5f/nihms-428309-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/4a4c298477fc/nihms-428309-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/ef94f2c863ec/nihms-428309-f0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/df33962e90e9/nihms-428309-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/e216aeef4268/nihms-428309-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/01c376fceb5f/nihms-428309-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/4a4c298477fc/nihms-428309-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cde/3581748/ef94f2c863ec/nihms-428309-f0005.jpg

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