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目的:探讨皮肤交感反应(SSR)测定在小纤维感觉神经病诊断中的应用价值。方法:选取20例神经传导速度(NCV)正常但具有典型小纤维损害症状的患者(NCV正常组)和26名健康对照者(对照组),取刺激强度为20 mA,脉宽为0.2ms,刺激右侧正中神经,记录波形(P/N)、潜伏期、波幅和曲线下面积测定SSR值。分析SSR的波形特征,评价受试者的交感节后C类小纤维功能,探讨具有典型小纤维损害症状但肌电图和NCV正常患者是否有小纤维损害的证据。结果:NCV正常组与对照组比较,手部SSR无明显差异;而足部潜伏期(P<0.01)和曲线下面积两组间比较,差异有统计学意义(P=0.03)。结论:NCV正常组患者足部SSR有长度依赖性损害表现,提示有早期罹患交感节后C类小纤维损害的可能。
Objective: To investigate the value of skin sympathetic reaction (SSR) in the diagnosis of small fiber sensory neuropathy. Methods: Twenty patients (normal NCV group) and 26 healthy controls (control group) with normal nerve conduction velocity (NCV) but typical symptoms of small fiber damage were selected. The intensity of stimulation was 20 mA, pulse duration was 0.2 ms, The right median nerve was stimulated, the recording waveform (P / N), latency, amplitude and area under the curve were used to determine SSR values. The waveform characteristics of SSR were analyzed and the sympathetic postganglionic class C fibril function was evaluated. The evidence of typical fibrillary lesions and the presence of fibrillary lesions in patients with normal electromyogram and NCV was investigated. Results: There was no significant difference in hand SSR between normal NCV group and control group. There was significant difference between the two groups in foot latency (P <0.01) and area under curve (P = 0.03). CONCLUSIONS: The SSR of foot in the normal NCV group shows length-dependent damage, suggesting the possibility of early post-sympathetic Class C fibrosis.