Knill-Jones R P, Goodwill C J, Dayan A D, Williams R
J Neurol Neurosurg Psychiatry. 1972 Feb;35(1):22-30. doi: 10.1136/jnnp.35.1.22.
In a prospective study of 70 unselected patients with chronic liver disease, clinical signs of a peripheral neuropathy were observed in 13 patients. Abnormal nerve conduction was demonstrated in nine of these and in one further patient who had no abnormal neurological signs. The occurrence of a neuropathy (in patients with cryptogenic cirrhosis, haemochromatosis, active chronic hepatitis as well as in alcoholic cirrhosis) could not be related to liver function, although it was associated with higher IgA and IgM values. Clinical diabetes was present in six of the 14 patients with neuropathy but there was no relation in the non-diabetic patients between neuropathy and minor impairment of carbohydrate tolerance. Those with neuropathy had a significantly higher incidence of oesophageal varices and there was also a relationship to a history of previous encephalopathy. Sural nerve biopsy was carried out on 14 patients, eight of whom had clinical or electrodiagnostic evidence of neuropathy. Single nerve fibres were examined by teasing and in all nerves histological evidence was found of an indolent process which had damaged whole Schwann cells and which resulted in demyelination and remyelination. Diabetic angiopathy was not seen and axonal degeneration, which was never severe, was found in all disease groups equally.
在一项对70例未经挑选的慢性肝病患者的前瞻性研究中，13例患者出现了周围神经病变的临床体征。其中9例以及另外1例无异常神经体征的患者存在神经传导异常。神经病变（在隐源性肝硬化、血色素沉着症、活动性慢性肝炎以及酒精性肝硬化患者中）的发生与肝功能无关，尽管它与较高的IgA和IgM值相关。14例神经病变患者中有6例存在临床糖尿病，但在非糖尿病患者中，神经病变与轻度糖耐量受损之间没有关联。患有神经病变的患者食管静脉曲张的发生率显著更高，并且与既往肝性脑病病史也有关系。对14例患者进行了腓肠神经活检，其中8例有神经病变的临床或电诊断证据。通过分离检查单根神经纤维，在所有神经中均发现有一个进展缓慢的过程的组织学证据，该过程损害了整个施万细胞，导致脱髓鞘和再髓鞘形成。未发现糖尿病性血管病变，并且在所有疾病组中均同样发现了从不严重的轴突变性。
