Shen Feifei, Dong Xin, Zhou Xin, Yan Lanyun, Wan Qi
Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People's Republic of China.
Department of Ophthalmology, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, People's Republic of China.
J Pain Res. 2019 May 13;12:1489-1495. doi: 10.2147/JPR.S196705. eCollection 2019.
It has been generally thought that activation and sensitization of the trigeminovascular system may contribute to the pathogenesis of migraine. Nevertheless, there is little evidence on abnormalities in peripheral trigeminal afferent nerves from humans in vivo. Alterations of corneal nerves from the ophthalmic branch of the trigeminal nerve may support the notion that trigeminal afferent nerves are involved in migraine pathophysiology. The aim of the present study was to investigate the structural changes in corneal subbasal nerve plexus in patients with episodic migraine (EM) with in vivo confocal microscope (IVCM). In this cross-sectional observational study, 10 EM patients and 10 age- and sex-matched healthy controls were included. Analysis of IVCM images with Image J software was performed to quantify the changes in the corneal subbasal nerve plexus. EM patients showed an increase in nerve fiber length (25.0±2.65 vs 22.3±2.41 mm/mm, =0.047) and nerve fiber density (36.3±7.29 vs 30.5±6.19 fibers/mm, =0.104) as compared with normal controls, but this difference was not statistically significant. Nerve branching and tortuosity were significantly increased in the EM subjects compared to the normal subjects (91.3±13.8 vs 75.0±14.2 branches/mm, =0.030 and 2.30±0.46 versus 1.63±0.52, =0.011, respectively). In addition, nerve sprouts and increased number of Langerhans cells were observed in the EM patients. The morphologic changes of corneal subbasal nerve plexus and Langerhans cell aggregation suggest the presence of nerve regeneration and inflammation in EM. Furthermore, the alterations of corneal nerves from the ophthalmic branch of the trigeminal nerve offer support for the hypothesis that the peripheral trigeminal system may be involved in the pathogenesis of migraine.
人们普遍认为，三叉神经血管系统的激活和致敏可能与偏头痛的发病机制有关。然而，几乎没有证据表明人类体内外周三叉神经传入神经存在异常。来自三叉神经眼支的角膜神经改变可能支持三叉神经传入神经参与偏头痛病理生理学的观点。本研究的目的是使用共聚焦显微镜（IVCM）研究发作性偏头痛（EM）患者角膜基底神经丛的结构变化。在这项横断面观察性研究中，纳入了10名EM患者和10名年龄和性别匹配的健康对照。使用Image J软件对IVCM图像进行分析，以量化角膜基底神经丛的变化。与正常对照组相比，EM患者的神经纤维长度增加（25.0±2.65 vs 22.3±2.41 mm/mm，P=0.047），神经纤维密度增加（36.3±7.29 vs 30.5±6.19根纤维/mm，P=0.104），但这种差异无统计学意义。与正常受试者相比，EM受试者的神经分支和迂曲明显增加（分别为91.3±13.8 vs 75.0±14.2分支/mm，P=0.030和2.30±0.46 vs 1.63±0.52，P=0.011）。此外，在EM患者中观察到神经芽和朗格汉斯细胞数量增加。角膜基底神经丛的形态学变化和朗格汉斯细胞聚集表明EM中存在神经再生和炎症。此外，来自三叉神经眼支的角膜神经改变为外周三叉神经系统可能参与偏头痛发病机制的假说提供了支持。
