Mouton P, Woimant F, Ille O, Prévot E, Mikol J, Haguenau M
Service de Neurologie, Hôpital Lariboisière, Paris.
Ann Med Interne (Paris). 1996;147(2):107-14.
Thermoregulation involves a long term adaptation system with hormonal processes and an immediate regulation system by extrapyramidal tracts, sympathetic part of autonomic nervous system and cortical integration of body temperature changes. Both system are under control of a hypothalamic center. Prolonged accidental exposure to intense cold and myxoedematous coma are the best known etiologies of hypothermia. However milder and often misdiagnosed hypothermia can occur at home in patients without endocrinologic disease. In these cases, hypothermia is due to dysfunction of immediate thermregulation under neuronal control, especially somatomotor and autonomic system. We report four cases of hypothermia of this kind. Two patients had an inhibition of peripherical mechanisms of protecting against cold (cutaneous vasoconstriction, shivering) and had dampened perception of cold: one was 73, had diabetes mellitus and took different drugs, the other one suffered from systemic lupus with myelopathy. The two other patients probably had a disorder of the thermoregulation hypothalamic center: one had Wernicke's encephalopathy and the other multiple sclerosis. From these cases and a review of the literature, we describe the different etiologies of hypothermia and their pathophysiology.
体温调节涉及一个由激素过程组成的长期适应系统和一个由锥体外系、自主神经系统交感部分以及体温变化的皮质整合构成的即时调节系统。这两个系统均受下丘脑中心控制。长期意外暴露于严寒和黏液水肿性昏迷是最常见的体温过低病因。然而，较轻且常被误诊的体温过低也可能在家中发生于无内分泌疾病的患者。在这些情况下，体温过低是由于神经元控制下即时体温调节功能障碍所致，尤其是躯体运动和自主神经系统。我们报告了4例此类体温过低病例。两名患者存在抵御寒冷的外周机制（皮肤血管收缩、颤抖）抑制，且对寒冷的感知减弱：一名73岁，患有糖尿病且服用多种药物，另一名患有系统性红斑狼疮伴脊髓病。另外两名患者可能存在体温调节下丘脑中心功能紊乱：一名患有韦尼克脑病，另一名患有多发性硬化症。通过这些病例及文献回顾，我们描述了体温过低的不同病因及其病理生理学。
