頁籤選單縮合
題 名 | Skin Biopsy: A New Window on Small-fiber Sensory Neuropathy |
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作 者 | Hsieh,Sung-tsang; | 書刊名 | Acta Neurologica Taiwanica |
卷 期 | 10:1 2001.03[民90.03] |
頁 次 | 頁1-8 |
分類號 | 415.9 |
關鍵詞 | Skin innervation; Skin biopsy; Epidermis; Nerve degeneration; Neuropathy; |
語 文 | 英文(English) |
英文摘要 | Sensory nerve terminals in the epidermis of the skin called free nerve endings are responsible for thermal and nociceptive stimuli. The examination of these nerves traditionally requires nerve biopsy at the ultrastructural level. Routine nerve conduction studies can only evaluate large myelinated nerves. Symptoms of neuropathy usually start from the distal parts of the extremities and follow a glove-stocking distribution. These phenomena raise the question of whether the skin could be used for the research and diagnosis of small-fiber sensory neuropathy. During the last five years, we have explore this issue using multidisciplinary approaches including: (1) the study of the pathology of cutaneous nerve degeneration/regeneration in various animal models, and (2) the examination of the pattern of cutaneous innervation in healthy subjects and neuropathic patients using the results of immunohistochemistry tests on 3 mm ppunches of skin biopsy specimens. As the first step in characterizing the pathology of epidermal nerve degeneration, we investigated temporal and spatial changes in skin innervation of the footpad of a mouse. Within 24 h after sciatic nerve axotomy, terminals of epidermal nerves appeared swollen. Epidermal nerves completely disappeared by 48 h. concomitant with the disappearance of epidermal nerves, the immunocytochemical pattern of the subepidermal nerve pleuxus became fragmented. Three months after crushing the nerve, the epidermis on the surgical side showed a normal innervation pattern resembling the epidermis on the control side. The characterstics of degenerating and regenerating nerves provide qualitative and quantitative information for interpreting the pathology of cutaneous nerves. We further extended these approaches to examine the cutaneous innervation in human subjects. In the distal area of the leg of 35 neuropathic patients, the epidermal nerve density was markedly reduced compared with 55 age- and gender-matched healthy control subjects (p<0.001). Dermal nerves of neuropathic patients became fragmented and swollen, similar to what was observed in animal studies. Epidermal nerve densities correlated variably with sensory thresholds of warm ad cold stimuli but had the best diagnostic efficiency when both sensitivity and specificity were considered. In conclusion, skin biopsy offers the advantage of studying temporal and spatial changes of sensory neuropathy. This is an entirely new field for both neuroscientists and neurologists. |
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