Miko T L, Le Maitre C, Kinfu Y
Armauer Hansen Research Institute (AHRI), All Africa Leprosy Rehabilitation and Training Centre (ALERT), Addis Ababa, Ethiopia.
Lancet. 1993 Aug 28;342(8870):521-5. doi: 10.1016/0140-6736(93)91647-5.
Despite the rapidly falling prevalence of leprosy, the disability and handicap resulting from loss of protective sensation, due to irreversible nerve damage, will remain a huge medical problem for many years. To elucidate the location and consequences of permanent nerve damage in treated leprosy, a prospective study involving nine patients who underwent leg amputation was conducted. Full-length nerves dissected from amputated legs were studied with histological and immunohistochemical methods. Our main findings were that: in both lepromatous and tuberculoid leprosy nerve damage increased distally, culminating in total destruction of dermal nerves and sensory nerve endings; after the therapy-related decrease of inflammation large-scale nerve regeneration took place; and that regenerating axons persisted for decades and in tuberculoid leprosy they might reach the subcutaneous fat of the plantar skin. We conclude that nerve regeneration was blocked by fibrous replacement of the distal-most nerves and nerve endings, and that the theoretical basis of nerve grafting in leprosy is in need of further clarification. In some patients, autologous transplantation of skin flaps, probably irrespective of the duration of loss of sensation, might help in regaining protective sensation.
尽管麻风病的患病率迅速下降，但由于不可逆转的神经损伤导致的保护性感觉丧失所造成的残疾和障碍，在许多年内仍将是一个巨大的医学问题。为了阐明经治疗的麻风病中永久性神经损伤的位置和后果，我们对9例接受截肢手术的患者进行了一项前瞻性研究。采用组织学和免疫组织化学方法对从截肢腿上解剖下来的全长神经进行了研究。我们的主要发现是：在瘤型和结核样型麻风病中，神经损伤均向远端加重，最终导致真皮神经和感觉神经末梢完全破坏；在与治疗相关的炎症减轻后，发生了大规模的神经再生；再生轴突持续数十年，在结核样型麻风病中，它们可能到达足底皮肤的皮下脂肪。我们得出结论，最远端神经和神经末梢的纤维替代阻碍了神经再生，麻风病中神经移植的理论基础需要进一步阐明。在一些患者中，自体皮瓣移植可能有助于恢复保护性感觉，而与感觉丧失的持续时间无关。
