Kennedy W R, Sakuta M, Sutherland D, Goetz F C
Ann Neurol. 1984 May;15(5):482-8. doi: 10.1002/ana.410150514.
This report introduces quantitative tests for the evaluation of sweating and the results obtained in 81 diabetic and 30 control subjects. The tests rely on the ability of pilocarpine, introduced into the skin by iontophoresis, to stimulate sweating from fully or partially innervated sweat glands but not from denervated glands. Many diabetic patients had a reduced number of excitable sweat glands and a low volume of sweat per square centimeter of skin. The results of the sweat tests correlated best with the clinically determined perception of pain from pinprick. The similar degree of involvement of sudomotor axons and pain-conveying axons may be related to the known similarity in size and reinnervation patterns. There was poor correlation of the sweating deficiency with alpha motor conduction velocity and with denervation of foot muscles as determined by the evoked muscle action potential. The number of excitable sweat glands was usually normal if the muscle action potential was above 0.5 mv, and often normal even when a muscle action potential was unobtainable. Every diabetic patient with abnormal sweating and several with normal sweating had reduced heart rate fluctuation during a standard Valsalva maneuver or during slow respiration.
本报告介绍了用于评估出汗情况的定量测试以及在81名糖尿病患者和30名对照受试者中获得的结果。这些测试依赖于通过离子电渗疗法导入皮肤的毛果芸香碱刺激完全或部分受神经支配的汗腺出汗的能力，而对去神经支配的汗腺则无此作用。许多糖尿病患者可兴奋汗腺数量减少，每平方厘米皮肤出汗量较低。出汗测试结果与临床测定的针刺疼痛感觉相关性最佳。发汗运动轴突和痛觉传导轴突的受累程度相似，可能与已知的大小和再支配模式相似有关。出汗功能缺陷与α运动传导速度以及由诱发肌肉动作电位确定的足部肌肉去神经支配之间的相关性较差。如果肌肉动作电位高于0.5毫伏，可兴奋汗腺的数量通常正常，即使无法获得肌肉动作电位时，汗腺数量也常常正常。每一位出汗异常的糖尿病患者以及几位出汗正常的患者在标准瓦尔萨尔瓦动作或缓慢呼吸过程中，心率波动均减小。
