Shimada H, Kihara M, Kosaka S, Ikeda H, Kawabata K, Tsutada T, Miki T
Department of Geriatrics and Neurology, Osaka City University Medical School, Japan.
Auton Neurosci. 2001 Sep 17;92(1-2):72-5. doi: 10.1016/S1566-0702(01)00287-9.
We evaluated postganglionic sympathetic function using the sympathetic skin response (SSR) and quantitative sudomotor axon reflex test (QSART) on the feet of 31 patients with early diabetic neuropathy and 20 age-matched normal controls. The amplitude of SSR and the sweat volume of QSART were significantly decreased in the diabetic patients. We evaluated the sensitivity of the tests in detecting autonomic failure. Out of 31 patients, 14 (45%) had abnormal SSR (14 absent; 17 present), while 16 of 31 patients (52%) had abnormal QSART (1 absent; 5 absolutely reduced and 10 showed a length-dependent pattern of reduction). More important than differences in sensitivity is the specificity of QSART, which specifically evaluates the postganglionic axon (instead of polysynaptic pathways in SSR) and provides quantitative data on the severity and pattern of autonomic deficit. In normal controls under 65 years of age, there was a significant correlation between the amplitude of SSR and the sweat volume of QSART. However, there was no significant relationship between these in diabetic patients. These results suggest that QSART can evaluate early diabetic neuropathy more precisely than SSR.
我们采用交感神经皮肤反应（SSR）和足部定量汗腺轴突反射试验（QSART），对31例早期糖尿病神经病变患者及20名年龄匹配的正常对照者的节后交感神经功能进行了评估。糖尿病患者的SSR波幅及QSART的出汗量均显著降低。我们评估了这些检查在检测自主神经功能衰竭方面的敏感性。31例患者中，14例（45%）SSR异常（14例消失；17例存在），而31例患者中有16例（52%）QSART异常（1例消失；5例绝对减少，10例呈长度依赖性减少模式）。比敏感性差异更重要的是QSART的特异性，它专门评估节后轴突（而非SSR中的多突触通路），并提供自主神经功能缺损严重程度及模式的定量数据。在65岁以下的正常对照者中，SSR波幅与QSART出汗量之间存在显著相关性。然而，糖尿病患者中二者无显著关系。这些结果表明，与SSR相比，QSART能更精确地评估早期糖尿病神经病变。
