Terada Kazufumi, Miyai Nobuyuki, Maejima Yuki, Sakaguchi Shunji, Tomura Taro, Yoshimasu Kouichi, Morioka Ikuharu, Miyashita Kazuhisa
Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Ind Health. 2007 Apr;45(2):309-17. doi: 10.2486/indhealth.45.309.
The objective of this study was to evaluate the usefulness of laser Doppler imaging (LDPI) of the skin blood flow for assessing peripheral vascular impairment in the hand-arm vibration syndrome (HAVS). The subjects were 46 male patients with HAVS, aged 50 to 69 yr, and 31 healthy male volunteers of similar age as controls. A cold provocation test was carried out by immersing a subject's hand on his more severely affected side into cold water at a temperature of 10 degrees C for 10 min. Repeated image scanning of skin blood flow of the index, middle, and ring fingers was performed every 2 min before, during, and after the cold water immersion using a PMI-II laser Doppler perfusion imager. The mean blood perfusion values in the distal phalanx area of the fingers were calculated on each image. The patients suffering from vibration-induced white finger (VWF, n=20) demonstrated significantly lower skin blood perfusion at each interval of the test as compared with those without VWF (n=26) and the controls (p<0.01, ANOVA). The blood perfusions in the HAVS patients were associated with the severity of the symptoms as classified by the Stockholm Workshop scale for vascular staging. When a subject was considered to be positive if any of the tested fingers showing a decreased blood perfusion and/or a delayed recovery pattern, the sensitivity was 80.0%, and the specificity was 84.6% and 93.5% for patients without VWF and the controls, respectively. These results suggest that the LDPI technique could provide detailed and accurate information that may help detect the existence of impaired vascular regulation to cold exposure in the fingers of workers exposed to hand-transmitted vibration.
本研究的目的是评估皮肤血流激光多普勒成像（LDPI）在评估手臂振动综合征（HAVS）外周血管损伤方面的实用性。研究对象为46名年龄在50至69岁之间的男性HAVS患者，以及31名年龄相仿的健康男性志愿者作为对照。通过将受试者受影响更严重一侧的手浸入10摄氏度的冷水中10分钟来进行冷激发试验。在冷水浸泡前、浸泡期间和浸泡后，每隔2分钟使用PMI-II激光多普勒灌注成像仪对手指的食指、中指和无名指的皮肤血流进行重复图像扫描。计算每个图像上手指远端指骨区域的平均血流灌注值。与无振动性白指（VWF，n = 26）的患者和对照组相比，患有振动性白指（VWF，n = 20）的患者在试验的每个时间段的皮肤血流灌注均显著降低（p < 0.01，方差分析）。HAVS患者的血流灌注与斯德哥尔摩研讨会血管分期量表所分类的症状严重程度相关。如果任何一个受试手指显示血流灌注降低和/或恢复模式延迟，则该受试者被视为阳性，此时对于无VWF的患者和对照组，敏感性分别为80.0%，特异性分别为84.6%和93.5%。这些结果表明，LDPI技术可以提供详细准确的信息，有助于检测接触手部传递振动的工人手指中对冷暴露血管调节受损的存在情况。
