Theriault M, Dort J, Sutherland G, Zochodne D W
Neurosciences Research Group, University of Calgary, Alberta, Canada.
Neurology. 1998 Feb;50(2):480-4. doi: 10.1212/wnl.50.2.480.
Sural nerve biopsy (Sbx) has been employed for the diagnosis of peripheral neuropathies and for multicenter trials of therapy in diabetic neuropathy. There is only limited prospective information available about what factors influence the resolution of the sensory deficit (Sdef) after biopsy.
We prospectively studied the surface area of skin Sdef after whole human Sbx in diabetic and nondiabetic patients for up to 18 months after the procedure. Sdef was determined by mapping, in two dimensions, the area of loss to pinprick and light touch in the sural distribution using a transparent boot-like device with 1-square-cm grid markings. At the same time, patients were interviewed about biopsy-related symptoms.
Overall, the Sdef in all patients declined by an average of 91 +/- 3% at 18 months. The pattern of Sdef decline indicated that collateral sprouting was the mechanism of sensory reinnervation. The extent of Sdef at 6, 12, or 18 months did not differ between diabetics and nondiabetics. In diabetics, there was a correlation between sensory reinnervation with pre-biopsy sural nerve potential amplitude and HbA1C level, but not with age or diabetes duration. Diabetic patients who had nerve resections starting at or below the center of a plane through the lateral malleolus and traveling proximally for 7 cm or less had a Sdef that was less than patients with longer and more proximal nerve resections. The majority of patients had unpleasant but mild mechanically elicited sensory symptoms at 1 year that had improved in most, but not all patients, by 18 months.
Sbx is associated with prolonged sensory symptoms and sensory loss. Recovery occurs by collateral reinnervation.
腓肠神经活检（Sbx）已被用于诊断周围神经病变以及糖尿病性神经病变治疗的多中心试验。关于活检后哪些因素会影响感觉障碍（Sdef）的恢复，目前仅有有限的前瞻性信息。
我们前瞻性地研究了糖尿病患者和非糖尿病患者在进行全人腓肠神经活检后长达18个月的皮肤感觉障碍表面积。使用带有1平方厘米网格标记的透明靴状装置，通过二维映射腓肠神经分布区域内针刺觉和轻触觉丧失的面积来确定感觉障碍。同时，对患者进行关于活检相关症状的访谈。
总体而言，所有患者的感觉障碍在18个月时平均下降了91±3%。感觉障碍下降的模式表明侧支发芽是感觉再支配的机制。糖尿病患者和非糖尿病患者在6个月、12个月或18个月时的感觉障碍程度没有差异。在糖尿病患者中，活检前腓肠神经电位振幅和糖化血红蛋白水平与感觉再支配之间存在相关性，但与年龄或糖尿病病程无关。从外踝中心或其以下开始并向近端延伸7厘米或更短距离进行神经切除的糖尿病患者，其感觉障碍程度低于神经切除更长且更靠近近端的患者。大多数患者在1年时有不愉快但轻微的机械性诱发感觉症状，到18个月时，大多数但并非所有患者的症状有所改善。
腓肠神经活检与长期的感觉症状和感觉丧失有关。恢复是通过侧支再支配实现的。
