Nilsson T, Burström L, Hagberg M, Lundström R
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Int Arch Occup Environ Health. 2008 Apr;81(5):519-33. doi: 10.1007/s00420-007-0258-0. Epub 2008 Jan 5.
Quantitative sensory testing assesses non-invasively the function of the sensory pathways from receptors to cortex. Studies of workers exposed to vibration support evidence that neuro-sensory hand-arm vibration syndrome also encompasses neuropathy of the small-diameter nerve fibres.
To assess the risk of disturbed thermal perception developing among young adults exposed to vibration and hand-intensive manual work. The aim also encompasses the study of alternative covariates in small-diameter nerve fibre neuropathy assessment.
This cross-sectional multi-centre study comprised 202 males and females from vocational school programs in auto mechanics, construction and catering. The testing included a baseline questionnaire, a clinical examination focusing on upper extremity disorders and quantitative somatosensory testing. Thermal perception thresholds were assessed, on both hands, second and fifth digits, using a modified Marstock method for warmth and cold.
Reduced thermal perception sensitivity was found for digit II compared to digit V, for females compared to males, and between the two study centres. Subjects exposed to vibration at work showed reduced sensitivity to temperature compared to non-vibration exposed. In univariate analyses odds ratios of 1.06 (95% CI 1.006-1.118) and 1.02 (95% CI 0.971-1.078) for reduced perception to cold for the right and left hands, respectively, was found for vibration. This association was lost in multivariate analyses. The study centre was the strongest confounding influence.
Sensitivity to temperature appears to be reduced despite the subjects short exposure-time and low exposure to vibration. The effect is small in relation to other confounding factors. A low agreement between the modalities indicates the need for separate tests for cold and warmth. Hand-side, age, stature, and BMI were not important for thermal perception but study centre, gender and choice of digit were. Conventional electro-diagnostic investigations are inadequate for evaluating the status of the small-fibre afferent systems leaving QST of thermal perception as the preferred diagnostic tool.
定量感觉测试可对从感受器到皮层的感觉通路功能进行非侵入性评估。对接触振动的工人进行的研究支持了这样的证据，即神经感觉性手臂振动综合征也包括小直径神经纤维的神经病变。
评估接触振动和手部高强度体力劳动的年轻人出现热感觉障碍的风险。该研究目的还包括在小直径神经纤维神经病变评估中对替代协变量的研究。
这项横断面多中心研究纳入了来自汽车修理、建筑和餐饮职业学校项目的202名男性和女性。测试包括一份基线问卷、一项以上肢疾病为重点的临床检查以及定量体感测试。使用改良的马尔斯托克方法对双手的食指和小指进行冷热感觉阈值评估。
与小指相比，食指的热感觉敏感性降低；女性比男性降低；两个研究中心之间也存在差异。与未接触振动的受试者相比，工作中接触振动的受试者对温度的敏感性降低。在单变量分析中，发现振动使右手和左手对冷感觉降低的优势比分别为1.06（95%可信区间1.006 - 1.118）和1.02（95%可信区间0.971 - 1.078）。在多变量分析中这种关联消失了。研究中心是最强的混杂影响因素。
尽管受试者接触振动的时间短且接触程度低，但对温度的敏感性似乎仍有所降低。与其他混杂因素相比，这种影响较小。不同方式之间的一致性较低，表明需要分别进行冷觉和热觉测试。手侧、年龄、身高和体重指数对热感觉并不重要，但研究中心、性别和手指选择很重要。传统的电诊断检查不足以评估小纤维传入系统的状态，热感觉定量感觉测试是评估小纤维传入系统状态的首选诊断工具。
