痛风患者自主神经功能障碍及交感皮肤反应特征分析

The characteristics of autonomic nerve dysfunction and sympathetic skin response in patients with gout

目的分析痛风患者自主神经功能障碍临床特点及交感皮肤反应特征。方法共纳入25例2017年3月至2018年1月确诊的痛风患者,其中合并痛风石者10例、有自主神经功能障碍症状(有症状)者8例,肌电图进行交感皮肤反应检测。结果痛风组患者表现为以汗腺功能异常为主的自主神经功能紊乱症状。与正常对照组相比,痛风组患者下肢潜伏期延长(Z=-2.136,P=0.033)、波幅降低(Z=-2.959,P=0.003)。有症状组患者下肢波幅分别低于正常对照组(Z=-3.426,P=0.001)和无症状组(Z=-3.308,P=0.001);痛风石组患者下肢波幅低于正常对照组(Z=-3.176,P=0.001)和无痛风石组(Z=-2.301,P=0.021),而无痛风石组下肢潜伏期延长(Z=-2.518,P=0.120)、波幅降低(Z=-2.327,P=0.020)。结论痛风患者自主神经功能存在异常,以下肢损伤为主,尤其合并痛风石或有自主神经功能障碍症状者更为明显,交感皮肤反应可以客观评价自主神经功能状态。

Objective To analyze the clinical features of autonomic nerve dysfunction and sympathetic skin response(SSR)in patients with gout.Methods A total of 25 patients with gout diagnosed from March 2017 to January 2018 were enrolled,including 10 patients with tophus and 8 patients with autonomic nerve dysfunction(symptomatic).EMG was used to detect SSR.Results The main symptoms of autonomic nervous dysfunction in the gout group were abnormal sweat glands.Compared with the normal control group,the lower extremity latency period of patients in the gout group was prolonged(Z=-2.136,P = 0.033)and the amplitude was reduced(Z =-2.959,P = 0.003).Lower extremity amplitude of the symptomatic group was lower than that of the normal control group(Z =-3.426,P = 0.001)and the asymptomatic group(Z =-3.308,P= 0.001).The lower extremity amplitude of patients in tophout group was lower than that in the control group(Z =-3.176,P=0.001)and the non-tophout group(Z =-2.301,P=0.021),while the lower extremity latency period of patients without tophout was prolonged(Z=-2.518,P=0.120)and the amplitude was reduced(Z=-2.327,P=0.020),which were statistically significant different from the control group.Conclusions Abnormal autonomic nerve function exists in gout patients,mainly in lower limb injury,especially in patients with tophus or symptoms of autonomic nerve dysfunction.SSR can objectively evaluate the autonomic nerve function state.