Painful and painless peripheral sensory neuropathies due to HIV infection: a comparison using quantitative sensory evaluation
Painful and painless peripheral sensory neuropathies due to HIV infection: a comparison using quantitative sensory evaluation
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DOI：
10.1016/s0304-3959(98)00227-9
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发表时间：
1999-03-01
期刊：
影响因子：
7.4
通讯作者：
Brasseur, L
中科院分区：
文献类型：
--
作者：
Bouhassira, D;Attal, N;Brasseur, L
为了进一步表征，感觉障碍，由于艾滋病毒引起的远端对称性多发性神经病（DSPN），我们比较了定量感觉测试（QST）和电诊断参数的患者疼痛或无痛DSPN。研究了40例HIV伴DSPN患者，并与10例血清阴性对照组进行了比较：15例患者出现下肢疼痛（自发和/或诱发），25例患者在年龄、性别、HIV持续时间和CD 4计数方面匹配，无疼痛症状（即感觉异常）。对下肢进行QST和神经传导检查（NCS）。vonFrey毛发和热测试装置用于确定机械和热、检测和疼痛阈值。在视觉模拟量表（VAS）上测量由阈上热刺激和机械刺激引起的反应，以评估痛觉过敏。NCS在两组患者之间无显著差异。与正常对照组相比，两组患者的热和机械检测阈值以及热痛阈值均显著增加。患者和对照组对阈上热刺激的反应相似。与此相反，机械疼痛阈值显着降低（机械异常性疼痛）和阈上机械刺激的反应显着增加（机械痛觉过敏）的疼痛，但不是在无痛患者。机械性异常性疼痛/痛觉过敏的强度与自发性持续疼痛的强度相关。我们得出结论，DSPN患者的特点是热，机械和电生理缺陷，提示在小和大的周围神经纤维的改变。疼痛性神经病变患者表现为静态机械异常性疼痛/痛觉过敏，提示机械感受性信号处理的选择性改变，这可能在这些患者的自发性和诱发性疼痛的病理生理学中起重要作用。(C)1999年国际疼痛研究协会。出版社：Elsevier Science B. V.
In order to characterize further, sensory disorders due to HIV-induced distal symmetrical polyneuropathy (DSPN), we compared quantitative sensory testing (QST) and electrodiagnostic parameters in patients presenting with painful or painless DSPN. Forty HIV patients with DSPN were studied and compared with ten seronegative control subjects: 15 patients presented with pains (spontaneous and/ or evoked) in the lower limbs and 25 patients, matched for age, sex, duration of HIV and CD4 count, had non-painful symptoms (i.e. paresthesia). QST and nerve conduction studies (NCS) were performed on the lower limbs. von Frey hairs and a thermotest device were used to determine the mechanical- and thermal-, detection and pain thresholds. The responses elicited by suprathreshold thermal and mechanical stimuli were measured on a visual analog scale (VAS), to evaluate hyperalgesia. NCS were not significantly different between the two groups of patients. Thermal and mechanical detection thresholds, as well as the thermal pain threshold were significantly, and similarly, increased in both groups of patients as compared with the normal control subjects. Responses to suprathreshold thermal stimuli were similar in patients and control subjects. In contrast, mechanical pain thresholds were significantly decreased (mechanical allodynia) and responses to suprathreshold mechanical stimuli significantly increased (mechanical hyperalgesia) in the pain, but not in the painless patients. The intensity of mechanical allodynia/hyperalgesia was correlated with the intensity of spontaneous ongoing pain. We conclude that patients with DSPN are characterized by thermal, mechanical and electrophysiological deficits, suggestive of alterations in both small and large peripheral nerve fibers. Patients with a painful neuropathy present with static mechanical allodynia/hyperalgesia, suggestive of a selective alteration in the processing of mechanoreceptive signals, which might have a significant role in the pathophysiology of spontaneous and evoked pains in these patients. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.