口腔黏膜温度感受阈与交感神经皮肤反应的相关研究

Correlation of perceptive temperature threshold of oral mucosa and sympathetic skin response

目的从生理水平探讨温度刺激引发的交感神经皮肤反应（sympathetic skin response，SSR）与主观认知感受之间的相关关系，为阐释温度觉形成的生理机制及辅助临床诊疗提供依据。方法纳入从天津医科大学招募的健康在校大学生志愿者42名，男性26名，女性16名，年龄（23±3）岁。按牙位统一将口腔黏膜进行分区，将温控测试仪的帕尔贴半导体片（10 mm×10 mm）置于分区中心部位，分别以37 ℃为基线温度，以间隔1 ℃的温度梯度刺激方式测试，记录冷、热温度感受阈值并绘制口腔黏膜温度感知地形图。以50 ℃作为基线温度，每次增加5 ℃，最高为60 ℃，上述温度刺激依次置于受试者的舌尖黏膜和下唇黏膜，检测温度刺激引发的SSR变化，同时用Mcgill量表评价志愿者的主观温度觉感受。对所得结果数据进行随机对照研究的方差分析和重复测量设计的广义估计方程分析。结果42名志愿者口腔黏膜不同分区的冷、热感知阈值间差异有统计学意义（P=0.013）。冷、热温度感知阈值表现为从中线向两侧逐渐增高，并且左右两侧对称，但不同性别之间温度感受阈差异无统计学意义[热感受阈：男性为（44.8±3.1）℃，女性为（44.8±3.2）℃，OR=1.100，P=0.930；冷感受阈：男性为（18.4±4.9）℃，女性为（20.8±4.8）℃，OR=0.157，P=0.210]。舌尖、下唇黏膜为特定区域的SSR振幅值随刺激温度的升高而升高[舌尖黏膜为（4.58±4.04）mv，P=0.001；下唇黏膜为（2.89±3.01）mv，P=0.013]，但温度刺激舌尖和下唇黏膜引发的振幅值不受性别的影响[舌尖黏膜：男性为（2.00±2.16）mv，女性为（1.89±1.20）mv，P=0.890；下唇黏膜：男性为（0.94±0.82）mv，女性为（0.85±0.68）mv，P=0.887]。SSR振幅值和志愿者在Mcgill量表中的VAS评分趋势一致。结论同等温度刺激下，口腔内唇颊黏膜、舌背黏膜和牙龈黏膜的主观温度感受不一致，通过SSR的量化评估，可以更客观地反映口腔黏膜对温度刺激的反应。

Objectives To explore the critical values of temperature perception in various mucosa sites of oral cavity and to draw the perceptive temperature threshold maps in healthy volunteers. To observe the interrelationship between subjective cognitive perception and sympathetic skin response （SSR） under various levels of thermal stimuli.Methods Forty-two healthy volunteers （recruited from the students of Tianjin Medical University, 16 females and 26 males） were enrolled in the present study. The whole oral mucosa of each subject was divided into multiple partitions according to the mucosa type as well as tooth position. Peltier patch （commodity name） semiconductor chip was placed in the central part of each subarea of the mucosa. The stimulus was increased or decreased at 1 ℃ each time from a baseline temperature of 37 ℃. Warm （WT） and cold （CT） perception thresholds were measured thereafter respectively. A topographic temperature map of the oral mucosa for each subject was drew. Furthermore, the SSR was elicited and recorded at three temperature levels of 50 ℃, 55 ℃, 60 ℃ respectively. Analog test with visual analogue scale （VAS） and McGill scales were also performed. Data were statistically analyzed with variance and generalized estimation equation.Results The tip of the tongue was the most sensitive area with both WT [（38.8±2.1） ℃, P〈0.05] and CT [（23.5±4.2） ℃, P〈0.05]. The highest heat threshold of gingival mucosa was in the left lower posterior teeth area [（49.9±3.7） ℃, P〈0.05], and the highest cold threshold of gingival mucosa was in the left upper posterior teeth area [（15.9±5.5） ℃, P〈0.05]. The perceptive temperature threshold increased gradually from the midline to both left and right sides were observed symmetrically and bilaterally. There was no statistically significant differences in temperature perception threshold between males and females [WT, male （44.8±3.1） ℃, female （44.8±3.2） ℃, OR=1.100, P=0.930; CT, Male （18.4±4.9） ℃, female （20.8±4.8） ℃, OR=0.157, P=0.210]. The SSR amplitude at sites of the tongue tip and the lower lip were increased with the rise of temperature [tongue tip （4.58±4.04） mv, P〈0.05, lower lip （2.89±3.01） mv, P〈0.05]. However, SSR amplitude values had no significant differences between males and females [tongue tip, male （2.00±2.16） mv, female （1.89±1.20） mv, P=0.890; lower lip, male （0.94±0.82） mv, female （0.85±0.68） mv, P=0.887]. Nevertheless, the amplitude of SSR and the VAS score of subjects showed a similar trend.Conclusions The temperature perception levels were different amongst sites of lip, buccal mucosa, tongue dorsal mucosa and gingival mucosa. SSR amplitude values could reflect the responses of the mouth to the thermal stimuli.