2010-08-012024-05-16https://scholars.lib.ntu.edu.tw/handle/123456789/669999摘要：神經病變是後期慢性腎病(尿毒症)患者一項重要的併發症，也是造成洗腎病人感覺症狀的主要原因。過去，尿毒症神經病變被認為是一種以感覺症狀為主的神經病變，而且是以侵犯大纖維神經為主。但是在後期慢性腎病患者有許多感覺症狀如麻、疼痛、灼熱、冰冷可能和小纖維神經之功能異常有關。另外慢性腎病患者也常有自律神經異常之症狀，而自律神經功能也是由小纖維神經所傳導。因此小纖維神經病變可能在慢性腎病患者的感覺異常及自律失調上扮演了重要角色，不過，目前對於其形成的過程和原因並不十分了解，之前少有相關研究探討小纖維神經在慢性腎病患者之變化。皮膚切片倂表皮內神經纖維密度檢查是一項病理檢查技術可以用來研究小纖維神經病變。接觸性熱刺激誘發電位是一項新的技術可以紀錄皮膚上的熱痛刺激在大腦所產生的電氣反應，它可用來評估小纖維神經傳導路徑的生理反應。本計畫的主旨是藉由皮膚切片倂神經密度及型態分析、感覺神經功能量化檢查、自律神經功能檢查及接觸性熱刺激誘發電位探討小纖維神經在慢性腎病患者之病理、功能及生理的變化；尋找慢性腎病造成小纖維神經病變之相關危險因子；洗腎、各種洗腎方式及腎臟移植對於小纖維神經病變的影響；及小纖維神經病變在慢性腎病患者之ㄧ些特殊感覺異常如神經痛、癢、或腳不寧症候群中所扮演的角色。以建立各種慢性腎病之神經症狀和小纖維神經病變之相關性，同時希望藉此可以早期診斷並預防慢性腎病相關之小纖維神經病變。<br> Abstract: Neurological dysfunction is a common complication of late stage chronic kidney disease (CKD) andperipheral nerve system is often involved in such complication. Sensory disturbances such as paresthesia andhypoesthesia are the predominant symptoms in uremic polyneuropathy and it is traditionally thought theuremic polyneuropathy mainly involve large-diameter sensory nerves. However in uremic patients theabnormal thermal thresholds, the sensory symptoms like numbness, burning, paradoxical heat, cold orfreezing, and pain, and the frequent symptoms of autonomic dysfunction suggest that small-fiber neuropathyshould be a clinical entity in patients of CKD. But there are still few investigations with emphasis on thechanges of small-fiber nerves in CKD, and little is known about the characteristics and mechanism ofsmall-fiber neuropathy in CKD. Skin biopsy with evaluation of epidermal nerve density and the morphologyof epidermal nerves and the subepidermal nerve plexus is an effective and minimally invasive test forassessment of small-fiber neuropathy. Contact heat evoked potential (CHEP) recording the brain responsesevoked by contact heat stimuli on the skin is a non-invasive technique to investigate the thermo-nociceptivepathways mediated by small-fiber nerves. In the current study, we will use an integrated approach bycombining the skin biopsy, quantitative sensory testing, autonomic function tests, and CHEP to investigatethe pathological, psychophysical and physiological aspects of small-fiber neuropathy in patients of CKD. Theaims of the current study is to address the following issues: (1) the changes of small fiber nerves in uremiaand CKD of different stage; (2) the correlation of skin innervation with clinical manifestations, thermalthresholds, and autonomic function; (3) the influence of dialysis therapy, the type of dialysis therapy, or renaltransplantation on the small fiber neuropathy in uremia; (4) the roles of blood chemical substances, metals,and endocrine profiles on the development of small-fiber neuropathy; (5) the relationship between thesmall-fiber neuropathy and pruritus or restless leg syndrome; and (6) the pathological and physiologicalcorrelates of painful symptoms by skin biopsy and CHEP in CKD related neuropathy. The results of thestudy will provide important insights in the understanding of the pathogenesis, and the prevention and newtreatments of small-fiber neuropathy in CKD.小纖維神經病變慢性腎病尿毒症皮膚切片接觸性熱刺激誘發電位感覺神經功能量化檢查搔癢small-fiber neuropathychronic kidney diseaseuremiaskin biopsycontact heat evoked potentialquantitative sensory testingpruritus