帕金森病患者皮肤小神经纤维病理研究  

Pathology study of small nerve fibers in the skin of patients with Parkinson

作　　者：朱啸巍 刘时华[1] 陈岩 张超[1] 吕雯露 蒋青青[2] 曹立 栾兴华 钟平[1] ZHU Xiaowei;LIU Shihua;CHEN Yan;ZHANG Chao;LYU Wenlu;JIANG Qingqing;Cao Li;LUAN Xinghua;ZHONG Ping(Suzhou Hospital of Anhui Medical University,Suzhou 234000,China;Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]安徽医科大学附属宿州医院,安徽宿州234000 [2]上海交通大学附属第六人民医院,上海200233

出　　处：《中国实用神经疾病杂志》2023年第3期277-284,共8页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81870889);安徽省高校科研项目(编号:2022AH050680)。

摘　　要：目的探讨帕金森病(PD)患者皮肤小神经纤维的病理特点。方法收集16例临床确诊并符合纳入和排除标准的PD患者和性别年龄匹配的16例健康对照者的临床资料和神经电生理结果,对PD症状及周围神经病变进行评估。所有受试者行小腿皮肤活组织检查,通过标准化泛轴突标记蛋白基因产物9.5(PGP9.5)和生长相关蛋白43(GAP-43)两种免疫组织化学染色定量表皮内神经纤维密度(Intraepidermal nerve fiber density,IENFD),并进行统计学分析。结果16例PD患者,男7例,女9例,年龄(66.000±9.675)岁,Hoehn and Yahr(H-Y)分期(1.906±0.612)。PD组尺神经、正中神经、腓肠神经远端感觉潜伏期较对照组延长(P<0.05),余2组间神经电生理结果未见统计学差异(P>0.05)。PD组PGP9.5和GAP-43染色下IENFD值均低于健康对照组(8.618±3.984根/mm vs18.198±5.387根/mm,4.543±3.363根/mm vs 14.174±5.485根/mm;P<0.05)。两种染色下IENFD值与PD的临床症状有相关性。GAP-43/PGP9.5染色下IENFD比值在2组之间无统计学差异(0.575±0.380 vs 0.787±0.218;P>0.05)。结论PD患者存在周围神经损害,以小神经纤维受累为主,大直径神经纤维受累不明显,皮肤活检是诊断PD小纤维神经病较为可靠的方法。Objective To explore the pathological characteristics of skin small nerve fibers in patients with Parkinson’s disease(PD).Methods Clinical data and neurophysiological assessments were collected from 16 PD patients who met the inclusion and exclusion criteria were included and 16 gender/age-matched controls to evaluate Parkinson’s symptoms and peripheral neuropathy.Skin biopsies taken from the distal lateral calf were ob⁃tained from all individuals and immunohistochemistry used to quantify intraepidermal nerve fiber density(IENFD)with protein gene product 9.5(PGP9.5)and growth-associated protein 43(GAP-43).The statistical analysis finally was performed.Results Sixteen patients with PD(7 males and 9 females),mean age:(66.000±9.675)years,Hoehn and Yahr(H-Y)stages:1.906±0.612.The distal sensory latency of ulnar,median and sural nerve in PD patients was longer than that of healthy control group(P<0.05)and there were no statistical differenc⁃es in in other indicators(P>0.05).IENFD for PGP9.5 and GAP-43 staining in PD group were lower than those in healthy control(8.618±3.984 fibers/mm vs 18.198±5.387 fibers/mm,4.543±3.363 fibers/mm vs 14.174±5.485 fibers/mm;P<0.05).IENFD for PGP9.5 and GAP-43 staining were correlated with clinical data.There was no sig⁃nificant difference in IENFD for GAP43/PGP9.5 ratio between PD and healthy control(0.575±0.380 vs 0.787±0.218).Conclusion PD patients have peripheral nerve damage,mainly involving small nerve fibers,while large nerve fibers are not obviously involved.Skin biopsy is a reliable method for diagnosing small fiber neuropathy in patients with PD.

关 键 词：帕金森病 皮肤活检 表皮内神经纤维密度 标准化泛轴突标记蛋白基因产物9.5 生长相关蛋白43 

分 类 号：R42.5[医药卫生—临床医学]