Objective:

2

To investigate the pathological features of blood stasis syndrome (BSS) in non-diabetic peripheral neuropathy.

Methods:

2

Clinical data of 31 patients with non-diabetic peripheral neuropathy who had undergone nerve biopsy during December 2004 and December 2010 in Xuanwu Hospital Capital Medical University were retrospectively analyzed. According to Chinese medicine (CM) syndrome differentiation and signs

26 patients were blood stasis type and 5 patients were non-blood stasis type. Clinical and pathological data were compared in detail.

Results:

2

Clinically

although both groups shared similar symptoms of limb numbness

weakness and sensory disturbances

the prevalence of neuralgia was much grievous in BSS group (73.1%

26/31) compared with the non-BSS group (0%

0/5). As for signs

dermal nutrients disturbance (84.6%

22/26)

dark or purple tongue (100.0%

26/26)

and sublingual varices (80.7%

21/26) were more common in the BSS group than the non-BSS group (0%

60%

20%

respectively). The prevalence of qi deficiency cases (19/26) in the BSS group was significantly higher compared with the non-BSS group (1/5). The unique histological manifestations of BSS were axonal degeneration (16/26 vs 2/5 in non-BSS group)

which was the hallmark of ischemia. Cases with BSS had prominent microangiopathy (61.5%

16/26)

manifested as epineurium vasculitis (inflammatory cell infiltrated to the vessel wall

obliteration and recanalization

vascular proliferation

extravascular hemosiderin deposition)

angiotelectasis

proliferation and hyaline degeneration of endoneurium capillary. In the BSS group

impaired blood-nerve barrier was indicated by sub-perineurial edema (46.2%

11/26) and endoneurial edema (15.4%

4/26). The Renaut body (15.4%

4/26) and amyloid deposition (3.8%

1/26) found in the BSS group were absent in the non-BSS group.

Conclusions:

2

BBS was common in non-diabetic peripheral neuropathies. The nerves exhibited ischemic alteration of primary axon degeneration and secondary demyelination. The interstitial tissue revealed microcirculation impairment

blood-nerve barrier disturbance

amyloid deposition and proliferation changes. The high prevalence of qi deficiency also highlights the therapy of promotion of blood circulation and removal of blood stasis.