Eduardo Alves Freire da Costa, Thaís Porto Amadeu, Ximena Illarramendi, Bernardo Pascarelli, José Augusto da Costa Nery, Anna Maria Sales, Sérgio Luiz Gomes Antunes
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We quantified dermal nerve damage via the nerve lesion index (NLI) and PGP9.5-immunoreactive axon quantitative index in dermal nerves (AQI). We also measured inflammatory involvement of adnexa in cutaneous samples as indirect evidence of HD.</p><p><strong>Results: </strong> We observed a higher median endoneurial inflammatory infiltrate NLI (HD = 0.5; INC = 0; OD = 0; <i>p</i> < 0.001) and more frequent inflammatory involvement of skin adnexa in samples of the HD group compared with those of the INC and OD groups (HD = 7; INC = 1; OD = 0). However, samples from the INC and OD groups also showed inflammatory and noninflammatory damage of dermal nerves, with 2 or more kinds of alterations in nerves in the same sample (respectively: INC = in 1 and 2 samples; OD = in 3 and 5 respectively). The quantification of PGP9.5-immunoreactive axons in dermal nerves revealed no difference between the groups.</p><p><strong>Conclusion: </strong> A detailed morphological analysis of cutaneous nerves in lesions with a suspicion of HD enabled us to select patients with nonspecific inflammatory or non-inflammatory lesions in the dermal nerves in the INC and OD groups, so they may be clinically monitored aiming at a possible future diagnosis of the disease. 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引用次数: 0
摘要
背景：如果在患者的皮肤样本中检测不到酸性禁食杆菌，汉森氏病（HD）的诊断就会很困难：目的：证明对疑似麻风病活检样本中真皮神经和皮肤附件的非特异性炎症和/或非炎症性改变进行详细的形态学分析可提高组织病理学诊断的效果：研究对象为有1至5处皮损的麻风病人，并根据皮肤组织病理学结果将其分为三组：汉森氏病（HD，n = 13）、其他疾病（OD，n = 11）和不确定病例（INC，n = 11）。我们通过神经损伤指数（NLI）和真皮神经PGP9.5免疫轴突定量指数（AQI）对真皮神经损伤进行量化。我们还测量了皮肤样本中附件的炎症受累情况，作为 HD 的间接证据：结果：我们观察到中位数较高的内膜炎症浸润 NLI（HD = 0.5；INC = 0；OD = 0；P 结论：通过对疑似 HD 病变的皮肤神经进行详细的形态学分析，我们在 INC 组和 OD 组中挑选出了真皮神经中存在非特异性炎症或非炎症病变的患者，以便对他们进行临床监测，从而在未来确诊该疾病。这些 INC 和 OD 患者不能肯定排除 HD 诊断，HD 可能与其他疾病并发。
Immunohistochemical and histopathological analyses of cutaneous innervation to improve the diagnostic efficacy in hansen disease skin lesion.
Background: The diagnosis of Hansen disease (HD) can be difficult when acid-fast bacilli are not detected in the patient's skin sample.
Objective: To demonstrate that detailed morphological analysis of nonspecific inflammatory and/or noninflammatory alterations in dermal nerves as well as skin adnexa in leprosy-suspected biopsy samples could improve the efficacy of histopathological diagnosis.
Methods: Patients with one to five skin lesions were enrolled in the study and classified into three groups by skin histopathology findings: Hansen disease (HD, n = 13), other diseases (OD, n = 11), and inconclusive cases (INC, n = 11). We quantified dermal nerve damage via the nerve lesion index (NLI) and PGP9.5-immunoreactive axon quantitative index in dermal nerves (AQI). We also measured inflammatory involvement of adnexa in cutaneous samples as indirect evidence of HD.
Results: We observed a higher median endoneurial inflammatory infiltrate NLI (HD = 0.5; INC = 0; OD = 0; p < 0.001) and more frequent inflammatory involvement of skin adnexa in samples of the HD group compared with those of the INC and OD groups (HD = 7; INC = 1; OD = 0). However, samples from the INC and OD groups also showed inflammatory and noninflammatory damage of dermal nerves, with 2 or more kinds of alterations in nerves in the same sample (respectively: INC = in 1 and 2 samples; OD = in 3 and 5 respectively). The quantification of PGP9.5-immunoreactive axons in dermal nerves revealed no difference between the groups.
Conclusion: A detailed morphological analysis of cutaneous nerves in lesions with a suspicion of HD enabled us to select patients with nonspecific inflammatory or non-inflammatory lesions in the dermal nerves in the INC and OD groups, so they may be clinically monitored aiming at a possible future diagnosis of the disease. These INC and OD patients cannot have the HD diagnosis definitely excluded, and HD may coexist with another disease as a comorbidity.
期刊介绍：
Arquivos de Neuro-Psiquiatria is the official journal of the Brazilian Academy of Neurology. The mission of the journal is to provide neurologists, specialists and researchers in Neurology and related fields with open access to original articles (clinical and translational research), editorials, reviews, historical papers, neuroimages and letters about published manuscripts. It also publishes the consensus and guidelines on Neurology, as well as educational and scientific material from the different scientific departments of the Brazilian Academy of Neurology.
The ultimate goals of the journal are to contribute to advance knowledge in the areas of Neurology and Neuroscience, and to provide valuable material for training and continuing education for neurologists and other health professionals working in the area. These goals might contribute to improving care for patients with neurological diseases. We aim to be the best Neuroscience journal in Latin America within the peer review system.
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