Villarroel Manoel F, Orsini Maria B P, Lima Ronise C, Antunes Carlos M F
Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Lepr Rev. 2007 Jun;78(2):102-9.
The objective of the present study was to compare the warm cold perception thresholds (WPT), cold perception thresholds (CPT) and the warm and cold perception interval (WCPI) determined in our previous study with the touch-pressure thresholds, in leprosy-suspected skin lesions ('patch'). Thermal testing was conducted using a thermal sensory analyser TSA-2001 (Medoc Ltd., Israel) and the method of levels. The touch-pressure thresholds were measured using Semmes-Weinstein monofilament (SWM) of 0-05 g, 0.2 g, 2 g, 4 g, 10 g and 300 g. A cross-sectional study of 112 patients presenting with leprosy-suspected skin lesions, with no clinical evidence of peripheral nerve damage, was conducted. Leprosy diagnoses were based on clinical dermato-neurological examinations. One-hundred-and-eight subjects (45 males, 63 females; average age 37.7 years) completed the tests: 82 were positively diagnosed with leprosy and 26 with diseases of different aetiologies. The SWM test showed a sensitivity of 81.7% and a specificity of 96.1%, while the warm and cold perception thresholds presented sensitivity of 90.2% and 92-2%, respectively (both with 100% specificity). In leprosy patients, lesions that exhibited pressure thresholds of 0.05 g typically showed significantly different WPT, CPT and WCPI values when compared with skin lesions of different aetiologies. Within the leprosy group, the mean values of WPT, CPT and WCPI increased according to the increase in touch-pressure thresholds. Some of the patients exhibiting leprosy lesions with touch-pressure thresholds of 0-05 and 0-2 g presented normal WPT or CPT values. However, all patients with SWM equal or above 2.0 g presented altered WPT and CPT. All patients with leprosy, including those that exhibited pressure thresholds of 0.05 g, presented altered WCPI in the skin lesions. Despite a higher sensitivity to thermal tests, the SWM has adequate validity as a screening tool in the diagnosis of cutaneous forms of leprosy and in the selection of patients who should be submitted to a more detailed examination.
本研究的目的是将我们之前研究中测定的温冷觉阈值(WPT)、冷觉阈值(CPT)以及温冷觉区间(WCPI)与麻风疑似皮肤损害(“斑片”)的触觉压力阈值进行比较。使用热感觉分析仪TSA - 2001(以色列Medoc有限公司)并采用阶梯法进行热测试。使用0.05 g、0.2 g、2 g、4 g、10 g和300 g的Semmes - Weinstein单丝(SWM)测量触觉压力阈值。对112例有麻风疑似皮肤损害且无周围神经损伤临床证据的患者进行了横断面研究。麻风诊断基于临床皮肤神经学检查。108名受试者(45名男性,63名女性;平均年龄37.7岁)完成了测试:82例被确诊为麻风,26例患有不同病因的疾病。SWM测试的灵敏度为81.7%,特异性为96.1%,而温觉和冷觉阈值的灵敏度分别为90.2%和92.2%(两者特异性均为100%)。在麻风患者中,与不同病因的皮肤损害相比,表现出压力阈值为0.05 g的损害通常显示出明显不同的WPT、CPT和WCPI值。在麻风组内,WPT、CPT和WCPI的平均值随着触觉压力阈值的增加而增加。一些表现出触觉压力阈值为0.05 g和0.2 g的麻风损害的患者呈现正常的WPT或CPT值。然而,所有SWM等于或高于2.0 g的患者均表现出WPT和CPT改变。所有麻风患者,包括那些表现出压力阈值为0.05 g的患者,其皮肤损害中的WCPI均发生改变。尽管热测试具有更高的灵敏度,但SWM作为一种筛查工具,在麻风皮肤型的诊断以及选择应接受更详细检查的患者方面具有足够的有效性。