Hoitsma E, Drent M, Verstraete E, Faber C G, Troost J, Spaans F, Reulen J P H
Department of Clinical Neurophysiology, Maastricht University Hospital, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Clin Neurophysiol. 2003 Dec;114(12):2326-33. doi: 10.1016/s1388-2457(03)00259-1.
A substantial number of sarcoidosis patients report apparently non-specific symptoms such as pain, for which no organic substrate has yet been found. Recently we observed symptoms suggestive of small-fibre neuropathy in a group of sarcoidosis patients. The aim of the present study was to verify this observation using various electrophysiological tests.
In 74 sarcoidosis patients complaining of symptoms suggestive of small-fibre neuropathy, thresholds for warm (WS) and cold sensation (CS) as well as for heat pain were determined at the thenar eminence and the foot dorsum. Furthermore, sympathetic skin responses (SSR), nerve conduction studies and concentric needle electromyography were performed. In 31 patients, cardiovascular autonomic testing was carried out.
Thermal threshold testing (TTT) revealed abnormalities in 51 of the 74 patients. Abnormalities showed an asymmetrical distribution. WS was affected more often than CS and feet more often than hands. Nerve conduction studies in the legs showed slightly abnormal results in 6 patients; all of these had abnormal TTT results. The SSR was absent at the foot in 7 patients. Cardiovascular autonomic testing was abnormal in only a single patient.
In a subgroup of sarcoidosis patients we found TTT abnormalities suggestive of small-fibre neuropathy. SSR and cardiovascular autonomic testing appeared to be of little diagnostic value. Small-fibre neuropathy may be the cause of a number of hitherto unexplained symptoms in sarcoidosis.
相当数量的结节病患者报告有疼痛等明显非特异性症状，目前尚未发现其器质性病变基础。最近我们在一组结节病患者中观察到提示小纤维神经病变的症状。本研究的目的是通过各种电生理测试来验证这一观察结果。
对74例主诉有提示小纤维神经病变症状的结节病患者，测定其大鱼际和足背的温觉（WS）、冷觉（CS）以及热痛阈值。此外，还进行了交感神经皮肤反应（SSR）、神经传导研究和同心针电极肌电图检查。对31例患者进行了心血管自主神经功能测试。
热阈值测试（TTT）显示，74例患者中有51例存在异常。异常表现为不对称分布。WS比CS更常受累，足部比手部更常受累。腿部神经传导研究显示6例患者结果略有异常；所有这些患者TTT结果均异常。7例患者足部SSR消失。仅1例患者心血管自主神经功能测试异常。
在结节病患者的一个亚组中，我们发现TTT异常提示小纤维神经病变。SSR和心血管自主神经功能测试似乎诊断价值不大。小纤维神经病变可能是结节病中许多迄今无法解释的症状的原因。
