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DOI 10.23648/UMBJ.2018.32.22690

УДК 616.833.002

БИОПСИЯ ПЕРИФЕРИЧЕСКИХ НЕРВОВ В ДИАГНОСТИКЕ ПОЛИНЕЙРОПАТИЙ

Д.А. Семикова¹, Н.А. Супонева¹, Д.А. Гришина¹, Р.В. Уренева², Н.В. Белова¹, А.М. Максимов¹, Е.В. Слесарева², В.В. Машин²

1 ФГБНУ «Научный центр неврологии», г. Москва, Россия;

2 ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Методика выделения нерва и спектр исследований был разработан более полувека назад в лаборатории патоморфологии нервов клиники Мэйо, (Миннесота) Питером Диком и коллегами. Несмотря на большое количество методов исследований, имеющихся сегодня в арсенале врача, биопсия нерва сохранила свое диагностическое значение. К ней прибегают в тех случаях, когда не удается установить причину нейропатии с помощью рутинных методов обследования.

Целью настоящего обзора является обсуждение информативности биопсии при различных заболеваниях периферических нервов. При направлении пациентов на эту процедуру необходимо четко понимать, на какие вопросы она может ответить. Изложенные морфологические методы исследования биоптатов нерва и получаемые при их использовании результаты позволят специалисту-неврологу оценить необходимость проведения такого рода диагностики. Спектр нозологий, приведенный в настоящем обзоре, показывает возможности использования морфологической диагностики при полинейропатиях неясного генеза.

Ключевые слова: полинейропатия, нейропатия, икроножный нерв, биопсия нерва, микроскопия.

Литература

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DOI 10.23648/UMBJ.2018.32.22690

BIOPSY OF PERIPHERAL NERVES IN DIAGNOSTICS OF POLYNEUROPATHY

D.A. Semikova¹, N.A. Suponeva¹, D.A. Grishina¹, R.V. Ureneva², N.V. Belova¹, A.M. Maksimov¹, E.V. Slesareva², V.V. Mashin²

1 Research Centre of Neurology, Moscow, Russia;

2 Ulyanovsk State University, Ulyanovsk, Russia

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Peter Dick and colleagues developed nerve isolation technique more than half a century ago in the laboratory of nerve pathomorphism, Mayo Clinic (Minnesota). Despite a large number of available research methods nerve biopsy has retained its diagnostic value. It is used in such cases when it is impossible to establish the cause of neuropathy using routine examination techniques.

The purpose of this review is to discuss the informativeness of biopsy in various peripheral nerve disorders. Patients undergoing the procedure should clearly understand what questions it can answer. The described morphological methods for nerve biopsy and the results obtained will allow a neurologist to assess the need for such a diagnostic technique. The nosology spectrum, given in this review, shows the possibilities of morphological diagnostics for idiopathetic polyneuropathies.

Keywords: polyneuropathy, neuropathy, sural nerve, nerve biopsy, microscopy.

Reference

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2. Mathis S., Magy L., Le Masson G. Value of nerve biopsy in the management of peripheral neuropathies. Expert Review of Neurotherapeutics. 2018; 18 (7): 589–602.

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5. Weis J., Brandner S., Lammens M. Processing of nerve biopsies: A practical guide for neuropathologists. Clinical Neuropathology. 2012; 31 (1): 7–23.

6. Mellgren S.I., Lindal S. Nerve biopsy – some comments on procedures and indications. Acta Neurol Scand. 2011; 124 (suppl. 191): 64–70.

7. Grant I.A. Differential diagnosis of diabetic neuropathies. In: Dyck P.J., Thomas P.K., eds. Diabetic Neuropathy. Ed. 2. Philadelphia: WB Saunders; 1999: 415–444.

8. King R., Ginsberg L. The nerve biopsy: indications, technical aspects, and contribution. In: Said G., Krarup C., eds. Handbook of Clinical Neurology. Vol. 115 (3-rd series): Peripheral Nerve Disorders. The Netherlands: Elsevier BV; 2013: 155–170.

9. Mathis S., Goizet C., Tazir M. Charcot-Marie-Tooth diseases: An update and some new proposals for the classification. J. Med. Genet. 2015; 52: 681–690.

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11. Vallat J.M., Mathis S., Funalot B. The various Charcot-Marie-Tooth diseases. Curr. Opin. Neurol. 2013; 26: 473–480.

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13. Duchesne M., Mathis S., Richard L. Nerve Biopsy Is Still Useful in Some Inherited Neuropathies. Journal of Neuropathology & Experimental Neurology. 2018; 77 (2): 88–99.

14. Ericson U., Ansved T., Borg K. Charcot-Marie-Tooth disease: muscle biopsy findings in relation to neurophysiology. Neuromuscul. Disord. 1998; 8: 175–181.

15. Said G. Indications and usefulness of nerve biopsy. Archives of neurology. 2002; 59 (10): 1532–1535.

16. Conceição I., González-Duarte A., Obici L. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J. Peripher. Nerv. Syst. 2016; 21: 5–9.

17. Mathis S., Magy L., Vallat J.M. Neuromuscular disorders in tropical areas. In: Preux P.M., Dumas M., eds. Neuroepidemiology in tropical health. 1-st ed. Elsevier-Academic Press (AP); 2018: 195–211.

20. Sommer C., Geber C., Young P. Polyneuropathies – etiology, diagnosis, and treatment options. Dtsch Arztebl Int. 2018; 115: 83–90.

21. Collins M.P., Hadden R.D. The nonsystemic vasculitic neuropathies. Nat. Rev. Neurol. 2017; 13: 302–316.

22. Pant I., Jha K., Singh R. Peripheral neuropathy and the role of nerve biopsy: A revisit. Indian J. Pathol Microbiol. 2018; 61 (3): 339–344.

23. Lawrence A., Nagappa M., Mahadevan A., Taly A.B. Vasculitic neuropathy in elderly: A study from a tertiary care university hospital in South India. Ann. Indian Acad. Neurol. 2016; 19: 323–326.

24. Khalili-Shirazi A., Gregson N.A., Londei M. The distribution of CD1 molecules in inflammatory neuropathy. J. Neurol. Sci. 1998; 158: 154–163.

25. Prayson R.A., Sedlock D.J. Clinicopathologic study of 43 patients with sural nerve vasculitis. Hum. Pathol. 2003; 34: 484–490.

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