Abbot N C, Beck J S, Rao B B, Feval F, Stanford J L, Weiss F, Mobayen M H
Department of Pathology, University of Dundee, Scotland.
Lepr Rev. 1994 Dec;65(4):341-9. doi: 10.5935/0305-7518.19940035.
Measurements of skin blood flow (by laser Doppler flowmetry) and temperature were made under environmental conditions promoting peripheral vasodilatation at the fingertips of a disfigured 'clawed' hand in 12 leprosy patients long-resident at Baba Baghi Leprosy Hospital, Tabriz, Iran. Sensory function was assessed by measuring the responses to light touch, pain and temperature of each finger, and peripheral autonomic function was gauged by estimating palmer sweating and by measuring skin vasomotor reflexes in response to inspiratory gasp. In 2 patients all measured fingers had laser Dopper flux (LDFlux) values and skin temperatures lower than the 95% confidence limits for the mean of 20 healthy controls, i.e. were impaired; in 2 patients all fingers had normal values for LDFlux and temperature; and in 8 patients there was a combination of impairment with most fingers normal for these parameters but with the small finger most commonly impaired. There were 10 (67%) fingers with impaired LDFlux and temperature values who had significant sensory impairment, whereas only 5 (18%) of the fingers with normal LDFlux values and temperatures had a similar sensory deficit. Overall, the fingers with the most impaired sensation had significantly (P < 0.05) lower LDFlux and temperature values than those with no sensory deficit. Microcirculatory impairment was not related to disordered skin vasometer reflexes or dysfunction of sweating. We concluded that the relationship between motor (skeletal muscle) nerve paralysis and any subsequent sensory neuropathy and/or microcirculatory impairment is more complex than might be expected from previous understanding of the disease.
在伊朗大不里士巴巴巴吉麻风病医院长期住院的12名麻风病患者的一只畸形“爪状”手的指尖，于促进外周血管舒张的环境条件下，进行了皮肤血流测量（通过激光多普勒血流仪）和温度测量。通过测量每个手指对轻触、疼痛和温度的反应来评估感觉功能，并通过估计手掌出汗情况以及测量对吸气喘息的皮肤血管运动反射来衡量外周自主神经功能。2名患者所有测量手指的激光多普勒通量（LDFlux）值和皮肤温度低于20名健康对照者均值的95%置信区间，即存在受损情况；2名患者所有手指的LDFlux值和温度均正常；8名患者存在受损与正常情况的组合，这些参数中大多数手指正常，但小指最常受损。LDFlux值和温度受损的手指中有10根（67%）存在明显的感觉障碍，而LDFlux值和温度正常的手指中只有5根（18%）有类似的感觉缺陷。总体而言，感觉受损最严重的手指的LDFlux值和温度显著低于（P<0.05）无感觉缺陷的手指。微循环损伤与皮肤血管舒缩反射紊乱或出汗功能障碍无关。我们得出结论，运动（骨骼肌）神经麻痹与任何后续的感觉神经病变和/或微循环损伤之间的关系比根据以往对该疾病的认识所预期的更为复杂。
