Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori 030-8553, Japan ; Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 306-8562, Japan.
Diabetes Center, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama 963-8558, Japan.
Parkinsons Dis. 2015;2015:167038. doi: 10.1155/2015/167038. Epub 2015 Apr 6.
Background. It is often difficult to differentiate Parkinson's disease (PD) from multiple system atrophy (MSA), especially in their early stages. Objectives. To examine the clinical utility of histopathological analysis of biopsied skin from the chest wall and/or leg in differentiating between the two diseases. Methods. Skin biopsies from the lower leg and/or anterior chest wall were obtained from 38 patients with idiopathic PD (26 treated with levodopa and 12 levodopa-naïve) and 13 age-matched patients with MSA. We sought aggregates of phosphorylated α-synuclein on cutaneous nerve fibers using double fluorescence immunohistochemistry and confocal microscopy and measured intraepidermal nerve fiber density (IENFD). Results. Phosphorylated α-synuclein aggregates were identified on cutaneous nerves in two patients with PD (5.3%) but in none of the patients with MSA, and IENFD was significantly lower in patients with PD when compared to those with MSA. There was no difference in IENFD between levodopa-treated and levodopa-naïve patients with PD. Conclusions. Our findings suggest that an assessment of IENFD in biopsied skin could be a useful means of differentiating between PD and MSA but that detection of α-synuclein aggregates on cutaneous nerves in the distal sites of the body is insufficiently sensitive.
帕金森病 (PD) 与多系统萎缩 (MSA) 很难区分，尤其是在疾病早期。目的：研究活检皮肤组织病理学分析对区分这两种疾病的临床应用价值。方法：对 38 例特发性 PD 患者（26 例接受左旋多巴治疗，12 例未接受左旋多巴治疗）和 13 例年龄匹配的 MSA 患者的小腿和/或前胸壁皮肤进行活检。我们采用双重荧光免疫组织化学和共聚焦显微镜检测皮肤神经纤维中磷酸化 α-突触核蛋白的聚集，并测量表皮内神经纤维密度 (IENFD)。结果：两名 PD 患者（5.3%）的皮肤神经中发现了磷酸化 α-突触核蛋白聚集，但在 MSA 患者中均未发现，与 MSA 患者相比，PD 患者的 IENFD 显著降低。接受左旋多巴治疗和未接受左旋多巴治疗的 PD 患者之间的 IENFD 没有差异。结论：我们的研究结果表明，活检皮肤的 IENFD 评估可能是区分 PD 和 MSA 的一种有用方法，但在身体远端部位的皮肤神经中检测到 α-突触核蛋白聚集的敏感性不足。
