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定量感觉测试

Quantitative sensory testing.

作者信息

Siao Peter, Cros Didier P

机构信息

Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA.

出版信息

Phys Med Rehabil Clin N Am. 2003 May;14(2):261-86. doi: 10.1016/s1047-9651(02)00122-5.

Abstract

Quantitative sensory testing is a reliable way of assessing large and small sensory nerve fiber function. Sensory deficits may be quantified and the data used in parametric statistical analysis in research studies and drug trials. It is an important addition to the neurophysiologic armamentarium, because conventional sensory nerve conduction tests only the large fibers. QST is a psychophysical test and lacks the objectivity of NCS. The results are subject to changes owing to distraction, boredom, mental fatigue, drowsiness, or confusion. When patients are consciously or unconsciously biased toward an abnormal QST result, no psychophysical testing can reliably distinguish these patients from those with organic disease. QST tests the integrity of the entire sensory neuraxis and is of no localizing value. Dysfunction of the peripheral nerves or central nervous system may give rise to abnormalities in QST. As is true for other neurophysiologic tests, QST results should always be interpreted in light of the patient's clinical presentation. Quantitative sensory testing has been shown to be reasonably reproducible over a period of days or weeks in normal subjects. Because longitudinal QST studies of patients in drug trials are usually performed over a period of several months to a few years, reproducibility studies on the placebo-control group should be included. For individual patients, more studies are needed to determine the maximum allowable difference between two QSTs that can be attributed to experimental error. The reproducibility of thermal thresholds may not be as good as that of vibration threshold. Different commercially available QST instruments have different specifications (thermode size, stimulus characteristics), testing protocols, algorithms, and normal values. Only QST instruments and their corresponding methodologies that have been shown to be reproducible should be used for research and patient care. The data in the literature do not allow conclusions regarding the superiority of any QST instruments. The future of QST is promising; however, many factors can affect QST results. As is true for other neurophysiologic tests, QST is susceptible to many extraneous factors and to misuse when not properly interpreted by the clinician.

摘要

定量感觉测试是评估大小感觉神经纤维功能的可靠方法。感觉缺陷可以被量化,并且这些数据可用于研究和药物试验中的参数统计分析。它是神经生理学手段的重要补充,因为传统的感觉神经传导测试仅检测大纤维。定量感觉测试是一种心理物理学测试,缺乏神经传导速度测试的客观性。结果容易因注意力分散、厌烦、精神疲劳、困倦或意识混乱而发生变化。当患者有意识或无意识地倾向于异常的定量感觉测试结果时,没有任何心理物理学测试能够可靠地将这些患者与患有器质性疾病的患者区分开来。定量感觉测试检测整个感觉神经轴的完整性,没有定位价值。周围神经或中枢神经系统功能障碍可能导致定量感觉测试异常。与其他神经生理学测试一样,定量感觉测试结果应始终根据患者的临床表现进行解释。在正常受试者中,定量感觉测试已被证明在数天或数周内具有合理的可重复性。由于药物试验中患者的纵向定量感觉测试研究通常持续数月至数年,因此应包括对安慰剂对照组的可重复性研究。对于个体患者,需要更多研究来确定两次定量感觉测试之间可归因于实验误差的最大允许差异。热阈值的可重复性可能不如振动阈值。不同的市售定量感觉测试仪器具有不同的规格(热刺激器大小、刺激特征)、测试方案、算法和正常值。只有已被证明具有可重复性的定量感觉测试仪器及其相应方法才可用于研究和患者护理。文献中的数据无法得出关于任何定量感觉测试仪器优越性的结论。定量感觉测试的前景广阔;然而,许多因素会影响定量感觉测试结果。与其他神经生理学测试一样,定量感觉测试容易受到许多外在因素的影响,并且如果临床医生没有正确解释,容易被滥用。

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