糖尿病患者の腓腹神経病変に関する病理組織学的研究

HISTOPATHOLOGICAL STUDIES OF THE SURAL NERVES IN THE DIABETIC PATIENTS

はじめに

　糖尿病の合併症として，末梢神経障害は重要な位置を占める。本障害の病態を明らかにする目的で，腓腹神経の病理学的検討は，Thomasら^1），　Ballinら^2），　Chopraら^3）により詳細に行われてきているが，本邦では田坂4），松岡ら^5），小坂ら^6）により主として光顕的研究が行なわれ，電子顕微鏡学的には小坂らが一部検討を加えているにすぎない。著者は6糖尿病例で腓腹神経生検を施行し，光顕および電顕的に腓腹神経病理所見に検討を加え，若干の知見を得たので報告する。

The fascicular biopsy of the sural nerves in the 6 diabetic patients was performed. The pathology of the sural nerves was investigated light-and electronmicroscopically, and concluded as follows :

1) In the myelinated fibers findings of both Wallerian degeneration and segmental demyelina-tion were almost equally encountered. The Waller-ian degeneration is partly subsequent to the seg-mental demyelination, but it must be considered that the primary Wallerian degeneration could exist in the patients.

2) The number of the myelinated fibers per square millimeter was remarkably decreased in 3 cases and slightly in 2 cases among 6.

3) The onion bulb structure was observed in 3 cases light-microscopically and in 4 cases electron-microscopically among 6 cases.

4) Degeneration of both unmyelinated fibers and Schwann cells was prominent in 4 cases among 6. It was observed at the almost same frequency as the degeneration of myelinated fibers. It is not specific, but it could be said that it has some significance in the pathology of the sural nerves in diabetic patients.