Giannini C, Dyck P J
Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Ann Neurol. 1994 Sep;36(3):408-15. doi: 10.1002/ana.410360312.
We evaluated 433 transversely sectioned microvessels from 54 sural nerves of diabetic patients with (43) and without (11) polyneuropathy and compared the findings with those of 366 microvessels from 50 sural nerves from controls, spanning the same ages. Whereas the number of microvessels per square millimeter and lumen areas and their size distribution were not significantly different between diabetic patients and controls, striking changes of the vessel wall were found in the nerves of diabetic patients. Mural area containing reduplicated basement membranes and pericyte degeneration were significantly increased in diabetic when compared with control nerves. A very low frequency of microvessel degeneration and endothelial cell separation was also encountered but only in diabetics with polyneuropathy. The microvessel changes we have found in nerve largely confirm and strengthen our previous findings. This study provides additional strong support for the idea that the mural changes of endoneurial microvessels do not relate to aging but do relate to diabetes mellitus. The structural alterations of endoneurial microvessel mirror changes seen in diabetic retinopathy and are sufficiently severe that they may accompany and account for functional alterations of the blood-nerve barrier and endoneurial microenvironment. It remains to be shown whether and how these changes relate to the development of polyneuropathy.
我们评估了54例糖尿病患者腓肠神经的433条横切微血管，其中43例患有多发性神经病，11例未患多发性神经病，并将结果与50例年龄跨度相同的对照者腓肠神经的366条微血管进行比较。糖尿病患者与对照者之间每平方毫米微血管数量、管腔面积及其大小分布无显著差异，但糖尿病患者神经中的血管壁有显著变化。与对照神经相比，糖尿病患者中含有重复基底膜的壁层面积和周细胞变性显著增加。微血管变性和内皮细胞分离的发生率很低，但仅在患有多发性神经病的糖尿病患者中出现。我们在神经中发现的微血管变化在很大程度上证实并强化了我们之前的发现。本研究为神经内膜微血管的壁层变化与衰老无关但与糖尿病有关这一观点提供了额外的有力支持。神经内膜微血管的结构改变反映了糖尿病视网膜病变中所见的变化，且足够严重，可能伴随并解释血神经屏障和神经内膜微环境的功能改变。这些变化是否以及如何与多发性神经病的发生相关仍有待证明。
