Ludolph A C, Spencer P S
Department of Neurology, Humboldt University, Berlin, Germany.
Baillieres Clin Neurol. 1995 Nov;4(3):505-27.
Peripheral neuropathy triggered by therapeutic drugs, workplace chemicals and environmental pollutants continues to be one of the most common pathological responses of the human nervous system to chemical attack. While some agents seem to damage the nerve cell directly, and a few induce primary demyelination, the large majority produces distal axonal degeneration simultaneously in long peripheral nerves and spinal tracts. Glove-and-stocking sensory loss typically precedes the development of a similar distribution of motor weakness. Clinical signs usually appear weeks after exposure has commenced; the condition continues to evolve after chemical exposure has ceased, and recovery spans a period of months or years. Careful clinical and laboratory assessment is needed to identify environmental agents responsible for human neuropathy, and reports of cases that claim a chemical causation require verification from experimental animal studies of suspect agents. Treatment of peripheral neuropathy continues to be limited, although a new therapeutic approach to patients with neuropathy-producing heavy metal intoxication is promising. Novel methods to limit nerve degeneration and promote regeneration are under study, but none has produced a convincing therapeutic effect. These are urgently needed to prevent and control the neuropathies that limit the therapeutic usefulness of drugs used in cancer chemotherapy and AIDS treatment.
由治疗药物、工作场所化学物质和环境污染物引发的周围神经病变，仍然是人类神经系统对化学侵害最常见的病理反应之一。虽然有些药物似乎直接损害神经细胞，少数药物会引发原发性脱髓鞘，但绝大多数药物会同时在长的周围神经和脊髓束中导致远端轴突变性。手套袜套样感觉丧失通常先于类似分布的运动无力出现。临床症状通常在接触开始数周后出现；在化学物质接触停止后病情仍会继续发展，恢复过程长达数月或数年。需要进行仔细的临床和实验室评估以确定导致人类神经病变的环境因素，而声称化学物质致病的病例报告需要通过对可疑物质进行实验动物研究来验证。周围神经病变的治疗仍然有限，尽管针对产生神经病变的重金属中毒患者的一种新治疗方法很有前景。限制神经变性和促进神经再生的新方法正在研究中，但尚无一种方法产生令人信服的治疗效果。迫切需要这些方法来预防和控制那些限制癌症化疗和艾滋病治疗中所用药物治疗效果的神经病变。
