Chelimsky T C, Low P A, Naessens J M, Wilson P R, Amadio P C, O'Brien P C
Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA.
Mayo Clin Proc. 1995 Nov;70(11):1029-40. doi: 10.4065/70.11.1029.
To attempt to characterize reflex sympathetic dystrophy (RSD) and to determine factors that would predict a response to sympathetic block.
We undertook a retrospective analysis on 396 patients with chronic limb pain referred for autonomic testing during a 5-year period.
Clinical endpoints were relief of pain after sympathetic block and a composite RSD diagnostic probability score, based on the clinical attributes of allodynia, protopathia, swelling, and vasomotor alterations. We compared the results of three autonomic tests--resting sweat output (RSO), resting skin temperature (RST), and quantitative sudomotor axon reflex test (QSART).
Increased RSO predicted the diagnosis of RSD with 94% specificity, and the specificity was 98% when RSO was considered in conjunction with an abnormal QSART result, the best laboratory correlate (P = 0.003) of the clinical diagnosis. Shorter duration of pain correlated with a warmer limb (P < 0.001), even in the absence of RSD. Response to a single sympathetic block did correlate with the diagnosis (P = 0.031) but correlated most significantly with short duration of pain in the arm (P = 0.001) and laboratory findings in the leg, where increased RST (P < 0.001) and QSART (P < 0.001) were near-perfect predictors of response.
Sweating abnormalities correlate strongly with the clinical syndrome of RSD, and alterations in RST may be superior to clinical findings in predicting the response to sympathetic block. The findings provide physiologic support for the unproven view of a natural disease progression ("stages"), with better treatment response and a warmer extremity initially. Because certain physiologic trends occur in all patients, general alterations of autonomic function with pain are suggested.
试图对反射性交感神经营养不良（RSD）进行特征描述，并确定可预测对交感神经阻滞反应的因素。
我们对5年间因慢性肢体疼痛转诊进行自主神经测试的396例患者进行了回顾性分析。
临床终点为交感神经阻滞后疼痛缓解以及基于异常性疼痛、原发性疼痛、肿胀和血管舒缩改变等临床特征的综合RSD诊断概率评分。我们比较了三种自主神经测试结果——静息出汗量（RSO）、静息皮肤温度（RST）和定量汗腺轴突反射试验（QSART）。
RSO升高对RSD诊断的特异性为94%，当RSO与异常QSART结果（临床诊断的最佳实验室相关指标，P = 0.003）一起考虑时，特异性为98%。疼痛持续时间较短与肢体温度较高相关（P < 0.001），即使在无RSD的情况下也是如此。对单次交感神经阻滞的反应与诊断相关（P = 0.031），但与手臂疼痛持续时间短（P = 0.001）以及腿部的实验室检查结果相关性最为显著，其中RST升高（P < 0.001）和QSART（P < 0.001）几乎是反应的完美预测指标。
出汗异常与RSD临床综合征密切相关，RST改变在预测对交感神经阻滞的反应方面可能优于临床检查结果。这些发现为未经证实的自然疾病进展（“阶段”）观点提供了生理学支持，即最初治疗反应较好且肢体较温暖。由于所有患者均出现某些生理趋势，提示疼痛时自主神经功能存在普遍改变。
