Ben Hamida M, Letaief F, Ben Hamida C
Acta Leprol. 1987 Apr-Jun;5(2):101-14.
A histomorphometric analysis of the superficial peroneal nerve was made in 15 cases of leprosy. Thirteen patients presented clinical signs of leprous neuropathy, while the other two showed only cutaneous signs of leprosy. The presence of M. leprae in all the nerves sampled, and the appearance of the histologic lesions, made it possible to confirm the diagnosis of leprosy and to specify the type of leprosy in each case, even in the absence of clinical signs of leprous neuropathy. Correlation of the histomorphometric results with the duration of development of the disease and with the time elapsing before treatment showed, in the beginning stage, a considerable reduction in myelinated and unmyelinated never fibres and a proliferation of Schwann cells, as well as segmental demyelination and axonal degeneration of the teased fibres. When treated early, the evolution of the lepromatous type (LL) appears favourable, with apparent regeneration of the nerve fibres. When treatment is not instituted early, gradual loss of nerve fibres, axonal degeneration of all the teased fibres, proliferation of the Schwann cell processes devoid of axons, and increase in endoneural connective tissue lead to a severe degeneration of the nerve. This unfavorable development appears to progress faster in the absence of treatment or when treatment is irregular. In the borderline lepromatous (BL) and borderline tuberculoid (BT) types, nerve degeneration appears to be more rapid than in the type LL.
对15例麻风病患者的腓浅神经进行了组织形态计量学分析。13例患者有麻风性神经病的临床体征，另外2例仅表现为麻风病的皮肤体征。在所取的所有神经中均发现麻风杆菌，且组织学病变的表现使得即使在没有麻风性神经病临床体征的情况下，也能够确诊麻风病并明确每例麻风病的类型。组织形态计量学结果与疾病发展持续时间以及治疗前经过时间的相关性显示，在疾病初期，有髓和无髓神经纤维显著减少，施万细胞增殖，同时有髓鞘纤维出现节段性脱髓鞘和轴突变性。早期治疗时，瘤型麻风（LL）的病情演变似乎较为有利，神经纤维有明显再生。若不及早治疗，神经纤维逐渐丧失，所有有髓鞘纤维轴突变性，无轴突的施万细胞突起增殖，神经内膜结缔组织增多，导致神经严重变性。在未治疗或治疗不规律的情况下，这种不利的病情发展似乎进展更快。在界线类偏瘤型（BL）和界线类偏结核型（BT）中，神经变性似乎比瘤型麻风（LL）更快。
