| There are abundant nerve fibers in skin which are the ends of peripheral nerves. 90% skin nerves are small diameter nerve fibers which diameter is less than seven micrometers. When peripheral nerves were damaged, even patients have no symptoms, skin nerves showed sensitively abnormality of quantity and morphology. The abnormality is closed related to injured degree of nerve which is early manifestation of many peripheral nerve diseases. But now routine electrodiagnostic studies primarily test large diameter nerve fiber function and can not test widespread small diameter nerve fibers in skin. And when the pathogenetic condition is light and histology and electrophysiology are not completely inconsistent small fiber neuropathy is often misdiagnosed as neurosis and arthropathy and so on. Therefore, to seek a kind of examinational technique which can detect the function of small diameter nerve fibers is a question to be solved in clinical practice.Skin nerve biopsy is a kind of examinational technique which can observe the pathology of skin sample. In combination with immunohistochemistry and histochemistry, it can intuitively quantify and observe the slim nerve fibers in skin. Skin biopsy has a number of advantages over conventional measures which is convenient,simple,inexpensive,minimally invasive,easily repeatable and quantitative and so on. Therefore, there is important clinical significance to carry out the quantitative and qualitative analysis of skin nerve fibers by using skin nerve biopsy for clinical diagnosis.Now in overseas, skin nerve biopsy has become a widely used technique to investigate small diameter nerve fibers injury. But because of few clinical data and sample and disunion methods, a great of disputation needs to explore and prove. So as a new diagnostic technique, skin nerve biopsy attract more and more scholars to participate in it.In china, a few scholars have carried out correlated study of skin nerve biopsy. But they only judge the injury degree according to their experience and nerve morphology and have no normal reference value. Their research results lack quantification index. Therefore, to carry out large sample quantitative and qualitative research in healthy human, to establish normal skin nerve quantification and morphology standard and to provide reference for early diagnosis of peripheral nerve diseases are very significative.Objective:To carry out the large sample quantitative and qualitative research in healthy human and establish the normal skin nerve quantitative and morphology standard.Methods:192 skin samples with different anatomic sites,ages and sexes were recruited and divided into six anatomic site groups (the distal upper arm, the distal forearm, dorsum of hand, the proximal thigh, the distal leg, dorsum of foot) , four age groups (below 20 years, 21~40 years, 41~60 years, above 61 years) and two sex groups (male and female). We carry out the quantitative and morphological observation of skin nerve fibers.1,The quantitative and morphological standard study of intraepidermal nerve fibers in healthy human.To adopt the PGP9.5immunohistochemical stain and C5 ocular micrometer to carry out the quantitative and morphological observation of intraepidermal nerve fibers, analyze the effect and regularity of ages, anatomic sites and sexes on IENFD and establish the normal reference value of each anatomic site where density of IENFD below the lower 5th percentile was considered abnormal.2,The quantitative and morphological standard study of sweat gland nerve fibers in healthy human.To adopt the cholinesterase histochemical stain and Image Pro Plus 6.0 image analysis software to carry out the quantitative and morphological observation of cholinergic nerve fibers and analyze the effect and regularity of ages, anatomic sites and sexes on density of sweat gland nerve fiber.Results:1,The quantitative and morphological standard study of intraepidermal nerve fibers in healthy human.There were intraepidermal nerve fibers, dermal nerve fibers, Meissner's corpuscles and autonomic nerve fibers immunoreactive to PGP9.5 The numerous intraepidermal nerve fibers arose from sub-papillary nerve bundles, passed through the dermis, parallelled the epidermis-dermis border, penetrated the basement membrane, moved vertically and upwards in the epidermis and ran toward the stratum corneum. The fibers were usually thin, sometimes varicose, tortuous and knobby. And they ran in different style and degree patterns. We observed the five kinds of patterns.Results showed: 1) The anatomic sites had an obvious effect on IENFD. The comparison of epidermal innervation among thigh, leg and dorsum of foot showed statistical significance (P<0.01). Likewise, the comparison of IENFD among upper arm, forearm and dorsum of hand showed statistical significance (P<0.01). And the comparison between dorsum of hand and dorsum of foot, leg and forearm and thigh and upper arm showed statistical significance (P<0.01). But the comparison between dorsum of hand and leg did not show statistical significance (P>0.05). Along with the limbs part from proximal to distal,the upper and lower limbs both manifested a degressive tendency by degrees; 2) Ages had a less effect on IENFD. Only the comparison between below 20 years and above 61 years showed statistical significance (P<0.01). And ages was negative correlated with IENFD; 3) Sexes had no effect on IENFD; 4) IENFD in distal leg was higher than that of Finnish by using the same method; 5) The normal reference value of each anatomic site: the upper arm was more than 320.00 fibers/mm2; the forearm was more than 190.57fibers/mm2; the dorsum of hand was more than 184.37 fibers/mm2; the thigh was more than 418.36fibers/mm2; the leg was more than 157.35fibers/mm2; the dorsum of foot was more than 140.00 fibers/mm2.2,The quantitative and morphological standard study of sweat gland nerve fibers in healthy human.Secretory portion of eccrine sweat gland was tubular. The tubular glandular organ hovered into irregular sphericity and was situated at dermis and hypodermis juncture. Cholinergic nerve fibers were brown and twisted around the sweat gland canaliculus in ring form. They were uneven, cluster or sparseness even colorless in arrangement and distribution.Results showed: 1) The anatomic sites had an obvious effect on density of sweat gland nerve fibers. The comparison of density of sweat gland nerve fibers between upper arm and forearm, forearm and dorsum of hand, and thigh and leg showed statistical significance (P<0.01). Likewise, the comparison of sweat gland innervation between forearm and leg and upper arm and thigh both showed statistical significance (P<0.01). But the comparison between leg and dorsum of foot, forearm and thigh, leg and dorsum of hand, and dorsum of hand and dorsum of foot did not showed statistical significance (P>0.05). Along with the limbs part from proximal to distal,the upper and lower limbs both manifested a degressive tendency by degrees, and the former was more obvious; 2) Ages had a more effect on density of sweat gland nerve fibers. Different age groups had obvious differences. The higher values were at below 20 years and above 61 years. And density of 21~40 year group was the lowest; 3) Density of male was higher than that of female.Conclusions:1,There were intraepidermal nerve fibers, dermal nerve fibers, Meissner's corpuscles and autonomic nerve fibers immunoreactive to PGP9.5 The numerous intraepidermal nerve fibers arose from sub-papillary nerve bundles, moved vertically and upwards in the epidermis and ran toward the stratum corneum.2,Secretory portion of eccrine sweat gland was tubular. The tubular glandular organ hovered into irregular sphericity. Cholinergic nerve fibers were brown and twisted around the sweat gland canaliculus in ring form. They were uneven in arrangement and distribution.3,The anatomic sites had obvious effect on IENFD and density of sweat gland nerve fibers. Along with the limbs part from proximal to distal, they manifested a degressive tendency by degrees. 4,The effect of ages on IENFD and density of sweat gland nerve fibers showed different regularities. The effect of ages on density of sweat gland nerve fiber compared with IENFD was more and this change was obviously undulate.5,Sexes had no obvious effect on IENFD; Density of sweat gland nerve fibers of male was higher than that of female.6,The normal reference value of each anatomic site: the upper arm was more than 320.00 fibers/mm~2; the forearm was more than 190.57fibers/mm~2; the dorsum of hand was more than 184.37fibers/mm~2; the thigh was more than 418.36fibers/mm~2; the leg was more than 157.35fibers/mm~2; the dorsum of foot was more than 140.00fibers/mm~2.7,IENFD between races of people was different. And IENFD of Chinese in distal leg was higher than that of Finnish by using the same method. |
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