Pathophysiology of hand-arm vibration syndrome and exposure limit for prevention

国际标准化组织（ISO）提出了预防手臂振动综合征的振动暴露指南。该指南是基于振动暴露的白种人雷诺现象的潜伏期，但证据不足。8 ~ 1000 Hz急性振动暴露实验结果如下：暴露手指的循环功能由于振动的直接作用而增加，而另一侧手指的循环功能由于通过自主神经系统的间接作用而下降。用尿儿茶酚胺对手臂振动综合征患者进行急性应激试验，发现交感肾上腺髓质对心理应激源的反应增加，特别是手臂振动综合征患者出现雷诺现象的频率更高。流行病学调查显示，日本普通人群的患病率低于白种人。振动暴露指南应考虑不同种族对循环障碍的易感性差异以及雷诺现象诱发振动暴露的发病机制。

Vibration exposure guidelines for prevention of the hand arm vibration syndrome are proposed by the International Organization for Standardization (ISO) . The guidelines are based on the latent interval of Raynaud's phenomenon among Caucasians exposed to vibration, however the evidences are not enough.Acute vibration exposure experiment form 8 Hz to 1000 Hz indicated the following results ; circulatory function of fingers exposed increased due to direct effect of vibration and that of the opposite side fingers decreased due to indirect effect via the autonomic nervous system.Acute stress test in hand-arm vibration syndrome patients using urinary catecholamines indicated the sympathoadrenal medullary response to psychological stressors increased especially in hand-arm vibration syndrome patients with Raynaud's phenomenon in higher frequency.Epidemiological investigation in Japanese general population indicated that the prevalence rates were lower than those in Caucasians. Difference of susceptibility to circulatory disturbance between races as well as pathogenesis of Raynaud's phenomenon induced vibration exposure should be considered for vibration exposure guidelines.