Sandroni P, Low P A, Ferrer T, Opfer-Gehrking T L, Willner C L, Wilson P R
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Clin J Pain. 1998 Dec;14(4):282-9. doi: 10.1097/00002508-199812000-00003.
To relate clinical features to autonomic laboratory indices used in the diagnosis of Complex Regional Pain Syndrome type I (CRPS I) (reflex sympathetic dystrophy) to generate improved diagnostic criteria.
CRPS I is a chronic pain syndrome, characterized by diffuse limb pain with allodynia and prominent vasomotor and sudomotor dysfunction.
We conducted a prospective study on 102 patients referred for possible CRPS I. These patients completed a structured questionnaire and underwent neurologic examination, with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor, and sensory, including pain, dysfunction. All patients were tested using a standard autonomic protocol that compared side-to-side skin temperature, resting sweat output, and quantitative sudomotor axon reflex test (QSART) measurements. Composite autonomic clinical (CRPS-Sx) and laboratory (CRPS-LAB) scores were defined. The clinical (subjective and objective) and the laboratory data were analyzed using Pearson's correlation analysis and Bonferroni's probability value to assess concordance and their value in correctly diagnosing CRPS I.
All cases occurred after limb injury. One-third of cases did not fulfill our criteria of CRPS I. Highly significant correlations (p<.001) were found among certain clusters of symptoms and signs that shared unifying pathophysiologies. CRPS-Sx correlated with CRPS-LAB (p = .035). The indices that correlated most reliably with clinical data and with each other were RSO, QSART, and skin temperature reductions.
Clinical and autonomic laboratory probability scores correlate in an internally consistent manner. Both CRPS-Sx and CRPS-LAB are sensitive and reliable tools to formulate a correct diagnosis of CRPS I and can be combined to provide an improved set of diagnostic criteria for CRPS I.
将临床特征与用于诊断Ⅰ型复杂性区域疼痛综合征（CRPSⅠ，反射性交感神经营养不良）的自主神经实验室指标相关联，以制定更完善的诊断标准。
CRPSⅠ是一种慢性疼痛综合征，其特征为肢体弥漫性疼痛伴痛觉过敏以及显著的血管舒缩和汗腺功能障碍。
我们对102例疑似CRPSⅠ的患者进行了一项前瞻性研究。这些患者完成了一份结构化问卷并接受了神经学检查，特别关注血管舒缩、汗腺、运动和感觉等临床特征的评估，包括疼痛和功能障碍。所有患者均采用标准自主神经检查方案进行检测，该方案比较双侧皮肤温度、静息出汗量以及定量汗腺轴突反射试验（QSART）测量值。定义了综合自主神经临床（CRPS-Sx）和实验室（CRPS-LAB）评分。使用Pearson相关分析和Bonferroni概率值对临床（主观和客观）及实验室数据进行分析，以评估一致性及其在正确诊断CRPSⅠ中的价值。
所有病例均发生在肢体损伤后。三分之一的病例不符合我们的CRPSⅠ标准。在具有统一病理生理学的某些症状和体征组之间发现了高度显著的相关性（p<0.001）。CRPS-Sx与CRPS-LAB相关（p = 0.035）。与临床数据以及彼此之间相关性最可靠的指标是静息出汗量、QSART和皮肤温度降低。
临床和自主神经实验室概率评分以内部一致的方式相关。CRPS-Sx和CRPS-LAB都是对CRPSⅠ进行正确诊断的敏感且可靠的工具，并且可以结合起来为CRPSⅠ提供一套改进的诊断标准。
