Villarroel Manoel F, Orsini Maria Beatriz P, Grossi Maria Aparecida F, Antunes Carlos Mauricio 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):110-21.
The aim of the present study was to determine the frequency of alteration in warm perception thresholds (WPT), cold perception thresholds (CPT) and the warm and cold perception interval (WCPI) in leprosy-suspected skin lesions, and to determine if these tests could assist in the diagnosis of leprosy. Tests were conducted using a thermal sensory analyser TSA-2001 (Medoc Ltd, Israel) and the method of levels. A cross-sectional study of 112 patients presenting leprosy-suspected skin lesions ('patch'), with no clinical evidence of peripheral nerve damage, was conducted. Leprosy diagnosis was based on clinical dermato-neurological examinations and complementary tests. 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 etiologies. The mean values of WPT (45-63 +/- 5.59), CPT (9.64 +/- 11.34) and WCPI 36.01 +/- 15.58) registered in leprosy-skin lesions were significantly different (P < 0.001) from lesions of diverse aetiologies and skin area without lesions. The cut-off point for WPT as determined from the ROC curve (receiver operating characteristic) was 35-10 degrees C, with a sensitivity of 90.2% and a specificity of 100%, and the corresponding cut-off point for CPT was 28.95 degrees C, with a sensitivity of 92.7% and a specificity of 100%. Nevertheless, all patients with leprosy presented a WCPI greater than 6.10 degrees C (ROC curve) in skin lesions. Increase in the thermal thresholds indicated warm hypoaesthesia, cold hypoaesthesia or both. The WCPI, which embraces both warm and cold perception thresholds, was the best indicator of thermal sensation, a term used in literature as a non-specific expression that does not describe warm and cold stimuli explicitly in terms of units of temperature.
本研究的目的是确定疑似麻风皮肤病变中热觉阈值（WPT）、冷觉阈值（CPT）以及冷热觉间隔（WCPI）的改变频率，并确定这些测试是否有助于麻风的诊断。测试使用热感觉分析仪TSA - 2001（以色列Medoc有限公司）及阶梯法进行。对112例有疑似麻风皮肤病变（“斑块”）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及补充检查。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。麻风皮肤病变中记录的WPT（45 - 63 ± 5.59）、CPT（9.64 ± 11.34）和WCPI（36.01 ± 15.58）的平均值与不同病因的病变及无病变的皮肤区域有显著差异（P < 0.001）。根据ROC曲线（受试者工作特征曲线）确定的WPT截止点为35 - 10℃，灵敏度为90.2%，特异性为100%，CPT的相应截止点为28.95℃，灵敏度为92.7%，特异性为100%。然而，所有麻风患者皮肤病变中的WCPI均大于6.10℃（ROC曲线）。热阈值升高表明存在热觉减退、冷觉减退或两者皆有。WCPI包含热觉和冷觉阈值，是热感觉的最佳指标，文献中使用该术语作为非特异性表达，未以温度单位明确描述热和冷刺激。
