Pruritus often escapes physicians' attention in patients with peripheral neuropathy (PNP). Here we aimed to characterize neuropathic pruritus in a cohort of 191 patients with PNP (large, mixed, or small fiber) and 57 control subjects with deep phenotyping in a multicenter cross-sectional observational study at 3 German sites. All participants underwent thorough neurological examination, nerve conduction studies, quantitative sensory testing, and skin biopsies to assess intraepidermal nerve fiber density. Patients filled in a set of questionnaires assessing the characteristics of pruritus and pain, the presence of depression and anxiety, and quality of life. Based on the severity of pruritus and pain, patients were grouped into 4 groups: "pruritus," "pain," "pruritus and pain," and "no pruritus/no pain." Although 11% (21/191) of patients reported pruritus as their only symptom, further 34.6% (66/191) reported pruritus and pain. Patients with pain (with or without pruritus) were more affected by anxiety, depression, and reduced quality of life than control subjects. Patients with pruritus (with and without pain) had increases in cold detection threshold, showing Aδ-fiber dysfunction. The pruritus group had lower intraepidermal nerve fiber density at the thigh, concomitant with a more proximal distribution of symptoms compared with the other PNP groups. Stratification of patients with PNP by using cross-sectional datasets and multinominal logistic regression analysis revealed distinct patterns for the patient groups. Together, our study sheds light on the presence of neuropathic pruritus in patients with PNP and its relationship with neuropathic pain, outlines the sensory and structural abnormalities associated with neuropathic pruritus, and highlights its impact on anxiety levels.

中文翻译：

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伴有和不伴有瘙痒的周围神经病的表型分析：一项横断面多中心研究。


周围神经病变 （PNP） 患者的瘙痒经常逃避医生的注意。在这里，我们旨在在 3 个德国地点的多中心横断面观察研究中，对 191 名 PNP 患者 （大、混合或小纤维） 和 57 名具有深表型的对照受试者的队列描述神经性瘙痒。所有参与者都接受了全面的神经系统检查、神经传导研究、定量感觉测试和皮肤活检，以评估表皮内神经纤维密度。患者填写了一组问卷，评估瘙痒和疼痛的特征、抑郁和焦虑的存在以及生活质量。根据瘙痒和疼痛的严重程度，将患者分为 4 组：“瘙痒”、“疼痛”、“瘙痒和疼痛”和“无瘙痒/无疼痛”。尽管 11% （21/191） 的患者报告瘙痒是他们唯一的症状，但另有 34.6% （66/191） 的患者报告瘙痒和疼痛。与对照组相比，疼痛患者 （伴或不伴瘙痒） 更容易受到焦虑、抑郁和生活质量下降的影响。瘙痒患者 （伴痛和不痛） 冷检测阈值增加，显示 Aδ 纤维功能障碍。瘙痒组大腿表皮内神经纤维密度较低，与其他 PNP 组相比，症状分布更近端。通过使用横断面数据集和多名词 logistic 回归分析对 PNP 患者进行分层，揭示了患者组的不同模式。 总之，我们的研究阐明了 PNP 患者存在神经性瘙痒症及其与神经性疼痛的关系，概述了与神经性瘙痒症相关的感觉和结构异常，并强调了其对焦虑水平的影响。