Said G, Lacroix-Ciaudo C, Fujimura H, Blas C, Faux N
Service de Neurologie, Hôpital de Bicêtre (Université Paris XI), France.
Ann Neurol. 1988 May;23(5):461-5. doi: 10.1002/ana.410230506.
We have reviewed the clinical and morphological data from 100 patients with necrotizing arteritis in muscle and/or in nerve samples taken by biopsy. The neuropathy occurred in the context of a multisystem disorder (Group 1) or in apparent isolation (Group 2). The average age of patients was 59 in Group 1 and 61 in Group 2. Females were more commonly affected than males, especially in the first group. Necrotizing arteritis complicated the course of rheumatoid arthritis in 25 patients. In 3 patients necrotizing arteritis was associated with infection with the human immunodeficiency virus, the agent of AIDS. Tests for hepatitis B surface antigen were positive in 19 patients. Mononeuritis was present in 13, mononeuritis multiplex in 62, and distal symmetrical sensory or sensorimotor neuropathy in 19 patients. In both groups of patients, the muscle biopsy was more frequently diagnostic for arteritis than was the nerve biopsy (80% versus 55%). The average incidence of isolated fibers undergoing axonal degeneration was 64.8%; that of demyelinated/remyelinated fibers was 1.9%. We conclude that the combination of nerve and muscle sampling increases the chance of visualizing characteristic arterial lesions in vasculitic neuropathy.
我们回顾了100例经活检获取的肌肉和/或神经样本显示患有坏死性动脉炎患者的临床和形态学数据。神经病变发生于多系统疾病背景下（第1组）或明显孤立存在（第2组）。第1组患者的平均年龄为59岁，第2组为61岁。女性比男性更易受累，尤其是在第一组。25例患者的坏死性动脉炎使类风湿关节炎病情复杂化。3例患者的坏死性动脉炎与人类免疫缺陷病毒（艾滋病病原体）感染有关。19例患者的乙肝表面抗原检测呈阳性。13例患者出现单神经炎，62例出现多发性单神经炎，19例出现远端对称性感觉或感觉运动性神经病变。在两组患者中，肌肉活检对动脉炎的诊断率比神经活检更高（80%对55%）。发生轴突变性的孤立纤维的平均发生率为64.8%；脱髓鞘/再髓鞘化纤维的发生率为1.9%。我们得出结论，神经和肌肉取样相结合可增加在血管炎性神经病变中发现特征性动脉病变的机会。
