Lang Philip M, Schober Gabriel M, Rolke Roman, Wagner Susanne, Hilge Robert, Offenbächer Martin, Treede Rolf-Detlef, Hoffmann Ulrich, Irnich Dominik
Department of Anesthesiology, University of Munich, Germany.
Pain. 2006 Sep;124(1-2):190-200. doi: 10.1016/j.pain.2006.04.011. Epub 2006 May 22.
Patients with peripheral arterial disease (PAD) may develop a broad range of peripheral nerve dysfunctions including pain and sensory deficiencies due to chronic ischemia mostly involving the lower limbs. To investigate the degree of sensory abnormalities in such patients quantitative sensory testing (QST) might be a useful tool. Forty-five patients and 20 controls were enrolled in the present study and underwent QST according to the protocol of the German Research Network on Neuropathic Pain. PAD was graded according to the Rutherford classification. PAD patients were divided into two groups: 16 patients with critical limb ischemia (severe PAD) and 29 patients with intermittent claudication (moderate PAD). QST revealed impaired cold and warm detection, increased mechanical and vibration detection thresholds, and increased perceptual wind-up on the affected leg (all p<0.001). Paradoxical heat sensation (p<0.05) and dynamic mechanical allodynia (p<0.01) were also observed. Subgroup analysis of patients without diabetes (control n=20, moderate PAD n=21, severe PAD n=8) confirmed most of these findings. In patients with severe PAD, sensory deficits were more pronounced than in patients with moderate PAD and were detected even in the face. These data indicate that QST can detect sensory abnormalities in PAD patients. While the pattern of decreased perception suggests deafferentation for Abeta-, Adelta-, and C-fiber inputs, the presence of allodynia suggests that central sensitization also plays a role in the pain state of PAD patients. Subgroup analysis points towards a PAD-associated peripheral neuropathy independent of diabetes.
外周动脉疾病（PAD）患者可能会出现广泛的外周神经功能障碍，包括因慢性缺血导致的疼痛和感觉缺陷，其中慢性缺血主要累及下肢。为了研究此类患者的感觉异常程度，定量感觉测试（QST）可能是一种有用的工具。本研究纳入了45例患者和20例对照，并根据德国神经性疼痛研究网络的方案进行了QST。PAD根据卢瑟福分类法进行分级。PAD患者分为两组：16例严重肢体缺血（重度PAD）患者和29例间歇性跛行（中度PAD）患者。QST显示患侧下肢冷觉和温觉检测受损、机械和振动检测阈值升高以及感觉总和增强（所有p<0.001）。还观察到了反常热感觉（p<0.05）和动态机械性异常性疼痛（p<0.01）。对无糖尿病患者的亚组分析（对照组n=20，中度PAD组n=21，重度PAD组n=8）证实了这些发现中的大部分。在重度PAD患者中，感觉缺陷比中度PAD患者更明显，甚至在面部也能检测到。这些数据表明QST可以检测PAD患者的感觉异常。虽然感觉减退模式提示Aβ、Aδ和C纤维传入缺失，但异常性疼痛的存在表明中枢敏化在PAD患者的疼痛状态中也起作用。亚组分析表明存在一种与PAD相关的、独立于糖尿病的外周神经病变。
