Division of Thoracic Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Ann Thorac Surg. 2013 Feb;95(2):465-70. doi: 10.1016/j.athoracsur.2012.10.068. Epub 2012 Dec 5.
The pathophysiologic characteristics of primary hyperhidrosis are not well understood and seem to be related to a sympathetic nervous system dysfunction. The resection of thoracic sympathetic chain ganglia is the most effective treatment for hyperhidrosis; however sympathetic ganglia function in normal individuals and in patients with hyperhidrosis is unknown.
A cross-sectional study, in which 2 groups of 20 subjects were analyzed: the hyperhidrosis group (HYP), comprised of patients with hyperhidrosis who were eligible for thoracic sympathectomy, and the control group (CON) comprised of brain-dead organ donors without a history of hyperhidrosis. For each subject, the following were performed: resection of the third left sympathetic ganglion, measurement of the ganglion's diameter, and immunohistochemical evaluation by quantification of strong and weak expression areas of primary antibodies against acetylcholine and alpha-7 neuronal nicotinic receptor subunit.
The presence of a strong alpha-7 subunit expression area was 4.85% in patients with primary hyperhidrosis and 2.34% in controls (p < 0.001), whereas the presence of a weak expression area was 11.48% in the HYP group and 4.59% in the CON group (p < 0.001). Strong acetylcholine expression was found in 4.95% of the total area in the HYP group and in 1.19% in the CON group (p < 0.001), whereas weak expression was found in 18.55% and 6.77% of the HYP and CON groups, respectively (p < 0.001). Furthermore, diameter of the ganglia was 0.71 cm in the HYP group and 0.53 cm in the CON group (p < 0.001).
There is a higher expression of acetylcholine and alpha-7 neuronal nicotinic receptor subunit in the sympathetic ganglia of patients with hyperhidrosis. Furthermore, the diameter of the thoracic sympathetic chain ganglia is larger in such patients.
原发性多汗症的病理生理特征尚不清楚，似乎与交感神经系统功能障碍有关。胸交感神经链切除术是治疗多汗症最有效的方法；然而，正常人和多汗症患者的交感神经节功能尚不清楚。
一项横断面研究，分析了 20 名患者的 2 组数据：多汗症组（HYP），由符合胸交感神经切除术条件的多汗症患者组成，对照组（CON）由无多汗症病史的脑死亡器官捐献者组成。对每位患者进行以下操作：切除第三左交感神经节，测量神经节直径，并通过定量分析针对乙酰胆碱和α-7 神经元烟碱受体亚单位的主要抗体的强和弱表达区域进行免疫组织化学评估。
原发性多汗症患者的α-7 亚单位强表达区域为 4.85%，对照组为 2.34%（p < 0.001），而 HYP 组的弱表达区域为 11.48%，CON 组为 4.59%（p < 0.001）。HYP 组总区域中有 4.95%存在强乙酰胆碱表达，CON 组中有 1.19%（p < 0.001），而 HYP 组和 CON 组的弱表达分别为 18.55%和 6.77%（p < 0.001）。此外，HYP 组的神经节直径为 0.71cm，CON 组为 0.53cm（p < 0.001）。
多汗症患者的交感神经节中乙酰胆碱和α-7 神经元烟碱受体亚单位表达较高。此外，此类患者的胸交感神经链神经节直径较大。
