Llewelyn J G, Thomas P K, Gilbey S G, Watkins P J, Muddle J R
Department of Neurological Science, Royal Free Hospital School of Medicine, London, UK.
Diabetologia. 1988 Mar;31(3):162-7. doi: 10.1007/BF00276850.
Sural nerve biopsies were obtained from 17 diabetic patients with neuropathy. All patients except three had both a symmetric distal sensory and autonomic polyneuropathy related to Type 1 (insulin-dependent) diabetes mellitus; 3 patients had a purely sensory polyneuropathy. Mean age was 34.5 years (range 18-53 years). The biopsies were compared with specimens from an age-matched control series. Myelinated fibre loss in the diabetic nerves was found to be nonuniform. Although patchy fibre loss has been considered to favour a vascular basis, an identical pattern of nonuniform loss was observed in a series of sural nerve biopsies from patients with Type I hereditary motor and sensory neuropathy, a subgroup within the spectrum of peroneal muscular atrophy, mainly of autosomal dominant inheritance, and a condition in which a vascular causation can be discounted. Possible reasons for nonuniform fibre loss other than vascular disease are discussed.
从17例患有神经病变的糖尿病患者身上获取了腓肠神经活检样本。除3例患者外，所有患者均患有与1型（胰岛素依赖型）糖尿病相关的对称性远端感觉和自主神经多神经病变；3例患者患有单纯性感觉性多神经病变。平均年龄为34.5岁（范围18 - 53岁）。将活检样本与年龄匹配的对照系列样本进行了比较。发现糖尿病神经中的有髓纤维损失并不均匀。尽管片状纤维损失被认为有利于血管性病因，但在一系列来自患有I型遗传性运动和感觉神经病变患者的腓肠神经活检样本中观察到了相同的不均匀损失模式，I型遗传性运动和感觉神经病变是腓骨肌萎缩症谱系中的一个亚组，主要为常染色体显性遗传，且这种情况下血管性病因可被排除。文中讨论了除血管疾病外纤维损失不均匀的可能原因。
