Graham A R, Johnson P C
Ann Neurol. 1985 May;17(5):450-4. doi: 10.1002/ana.410170506.
Direct immunofluorescence examination was performed on peripheral nerve from 16 patients with diabetes mellitus and 53 additional patients with peripheral neuropathy of diverse cause. Six nerves from patients with diabetes mellitus yielded positive findings: 4 had granular and lamellar deposition of IgM within the perineurium (of which 2 also had fibrinogen, IgA, C3, and albumin and 1 also had IgG); 1 had IgM, C3, and C4, and perineurial fibrinogen; the sixth contained linear perineurial C3 and fibrinogen. These 6 nerves contained axonal degeneration (3), axonal degeneration with chronic demyelination (1), microvasculitis with wallerian degeneration (1), and no pathological change (1). Sixteen of 53 nerves from nondiabetics yielded positive findings with immunofluorescence, possibly as a result of vascular leakage or as a manifestation of impaired removal of plasma proteins. The deposition of immunoreactants, as well as other plasma proteins, in peripheral nerve from patients with diabetes mellitus probably represents a "trapping" phenomenon reflecting altered basement membrane permeability. Alternatively, the changes could reflect a defect in the blood-nerve barrier in diabetic microangiopathy.
对16例糖尿病患者及另外53例病因各异的周围神经病变患者的周围神经进行了直接免疫荧光检查。6例糖尿病患者的神经检查结果呈阳性：4例在神经束膜内有IgM颗粒状和层状沉积（其中2例还含有纤维蛋白原、IgA、C3和白蛋白，1例还含有IgG）；1例含有IgM、C3和C4以及神经束膜纤维蛋白原；第6例含有神经束膜线性C3和纤维蛋白原。这6条神经存在轴突变性（3条）、伴有慢性脱髓鞘的轴突变性（1条）、伴有华勒变性的微血管炎（1条）以及无病理改变（1条）。53例非糖尿病患者的神经中有16例免疫荧光检查结果呈阳性，这可能是血管渗漏的结果，或者是血浆蛋白清除受损的表现。糖尿病患者周围神经中免疫反应物以及其他血浆蛋白的沉积可能代表一种“捕获”现象，反映了基底膜通透性的改变。或者，这些变化可能反映了糖尿病微血管病变中血-神经屏障的缺陷。
