Vasudevan T M, van Rij A M, Nukada H, Taylor P K
Department of Vascular Surgery, Dunedin Hospital, University of Otago Medical School, New Zealand.
Aust N Z J Surg. 2000 Jan;70(1):57-9. doi: 10.1046/j.1440-1622.2000.01744.x.
Wrinkling of the skin of the palm and sole is considered to be dependent on the presence of intact sympathetic nervous activity. Loss of sympathetic integrity could be simply and usefully assessed by the absence of wrinkling. To test this hypothesis, the skin wrinkle test was compared with the starch-iodine sweat test and sympathetic skin response (SSR) in patients with abnormal sympathetic function.
The three tests were carried out in 34 patients (68 limbs) undergoing temporary or permanent disruption of the sympathetic chain to upper or lower limbs. Included in this group were six diabetics undergoing chemical or surgical sympathectomy, lumbar epidural infusions following vascular surgery, and patients for whom sympathectomy was being considered. Sensitivity and specificity analysis and predictive values of the wrinkling response and the starch-iodine test were related to the SSR as the standard.
The wrinkle test showed a sensitivity of 97% and specificity of 95%, and bore good correlation to the SSR. The starch-iodine test showed sensitivity of 55% and specificity of 93%. A hypothesis for the mechanism of wrinkling based on the observations of the present study is proposed.
The wrinkle test is a reliable test of sympathetic function, is inexpensive and is easy to perform at the bedside. The sweat gland myo-epithelial cells and absence of sebum could play an important role in the wrinkling response. It can be used to select patients who will benefit from sympathectomy, and can adequately evaluate sympathetic blockade.
手掌和足底皮肤起皱被认为依赖于完整的交感神经活动。交感神经完整性的丧失可通过不起皱简单且有效地评估。为验证这一假设，在交感神经功能异常的患者中，将皮肤皱纹试验与淀粉碘汗液试验及交感皮肤反应（SSR）进行了比较。
对34例（68个肢体）接受上肢或下肢交感神经链临时或永久性阻断的患者进行了这三项试验。该组包括6例接受化学或手术交感神经切除术的糖尿病患者、血管手术后的腰椎硬膜外输注患者以及考虑进行交感神经切除术的患者。以SSR作为标准，对皱纹反应和淀粉碘试验的敏感性、特异性分析及预测值进行了分析。
皱纹试验的敏感性为97%，特异性为95%，与SSR具有良好的相关性。淀粉碘试验的敏感性为55%，特异性为93%。基于本研究的观察结果，提出了一种皱纹形成机制的假设。
皱纹试验是一种可靠的交感神经功能检测方法，成本低廉且易于在床边进行。汗腺肌上皮细胞和皮脂缺乏可能在皱纹反应中起重要作用。它可用于选择将从交感神经切除术中获益的患者，并可充分评估交感神经阻滞情况。
