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Brain and Nerve No to Shinkei Volume 31, Issue 4 （April 1979）

Brain and Nerve 脳と神経 31巻4号（1979年4月発行）

Japanese English

原著

らいの末梢神経障害の病理組織学的研究—剖検症例について PERIPHERAL NERVE INVOLVEMENT IN LEPROSY : NEUROPATHOLOGICAL STUDY ON AUTOPSY CASES 向山昌邦 ^1,2 , 佐々木紀典 ³ Masakuni Mukoyama ^1,2 , Norisuke Sasaki ³ ¹国立神経センター ²名古屋大学医学部第一内科 ³国立多摩研究所 ¹National Center for Nervous, Mental and Muscular Disorders ²The First Department of Internal Medicine, Nagoya University School of Medicine ³National Institute for Leprosy Research pp.403-408

発行日 1979年4月1日 Published Date 1979/4/1

DOI https://doi.org/10.11477/mf.1406204401

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Abstract 文献概要
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I．はじめに

　らいは末梢神経障害を伴いやすいことがよく知られている^6）。最近は治療薬の開発により，早期に治療を受けるため，らいの末梢神経障害もある程度は重症化を防止されている。また，わが国では，らい患者が全体に老齢化しており，これらの患者に末梢神経障害を認めた場合，老齢による要因も考えねばならない。

　このような状況下にあるらい患者の末梢神経病変を，病理形態学的に検討する機会を得たので，検索の結果を報告し，これらの病変について若干の考察をおこなう。

Sciatic, tibial and peroneal nerves were neuro-pathologically investigated on four autopsy cases of leprosy. Loss of myelinated nerve fiber with proliferation of connective tissue was observed in each peripheral nerve, prominently in two cases and moderately in other two cases. The difference about the grade of pathological alterations amongthe sciatic, tibial and peroneal nerves was not proved in each case.

Lymphocyte infiltration was found in two cases in epi-, and perineurial areas of the nerves. Lepra bacilli were detected in one case with special straining method (methenamine silver staining).

Thickening and hyaline degeneration of the wall of perineurial blood vessels were observed in all cases.

Multinuclear giant cells, abscess or amyloid substance were not found in the peripheral nerves in this study.

In morphometric study, performed on the sural nerves of two cases, total myelinated fiber density decreased to 10,400/mm² and 7,300/mm², respective-ty. Histogram showed unimodal distribution withloss of larger myelinated nerve fibers.

In nerve teasing study, variation in internodal length was seen in each sural nerve in two cases, which meaned segmental de-, and remyelination. At the same time, the nerve fibers with small internodal length, regardless of fiber diameter, were found in one of these cases, which demonstrated coexistence of wallerian degeneration.

The pathological alterations, observed in the peripheral nerves of the leprosy patients, are considered to be provided by various factors, such as the disease type (L or T type), the therapeutic treatments which were given to the patient during the clinical course, the disease stage at pathologic examination and the effect of aging.