躯体形式障碍患者定量感觉检查的研究

目的 用定量感觉检查的方法了解躯体形式障碍患者的感觉改变.方法 用定量感觉仪对27名躯体形式障碍患者,分别用Limit法和Level法测定四肢的冷觉(CS)、温觉(WS)、热痛觉(HP)、冷痛觉(CP)、振动觉(WT)阈值,并与19名正常人的CS、WS、HP、CP、WT阈值进行对比.结果 Limits法显示躯体形式障碍组与对照组间除左上肢的冷痛觉、振动觉、右上肢的冷痛觉、右下肢的冷觉、冷痛觉阈值差异无显著性外,其余15项定量感觉值均差异有显著性[左上肢的热痛觉分别为(39.79±1.29)℃,(43.17±1.10)℃],t=9.2835,P＜0.01,左下肢的热痛觉分别为[(16.46±3.41)℃,(14.72±1.10)℃,t=2.1410,P＜0.05].其中11个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅4个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为55%,高于20%的升高率,差异有显著性(x2=5.2267,P＜0.05).Levels法显示2组间除右下肢的冷觉差异无显著性外,其余各定量感觉阈值亦差异有显著性[右下肢的振动觉分别为(1.07±0.13)Hz,(1.33±0.03)Hz,t=8.5327,P＜0.01]左下肢的冷觉分别为[(28.73±0.69)Hz,(28.08±0.63)Hz,t=3.2587,P＜0.01].且其中8个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅3个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为67%,高于25%的升高率,差异有显著性(x2=4.1958,P＜0.05).Limits法和Levels法阈值降低或升高率差异无显著性(P＞0.05).结论 Limits和Level法的定量感觉检查均提示躯体形式障碍出现感觉阈值下降、感觉敏感性增加的可能性较大;躯体形式障碍所产生的感觉障碍可能与周围和中枢神经敏感性均增高有关.

The report of the study to somatofom disorders by quantitative sensory testing

Objective This study was to find the change of the patiens with somatoform disorders.Methods The quantitative sensory testing(QST)threshold values of CS,WS,HP,CP,WT were got by method of Limit and Level,and compare those values of the somatoform disorders group with those of control group.Results The Limit method showed that the threshold values was significantly different in two groups,except tlle CP,WT of left upper limb,the CP of fight upper limb,the CS,CP of right lower timb(LA-HP:39.79±1.29,43.17±1.10,t=9.2835,P＜0.01,LF-HP:16.46±3.41 14.72±1.10,t=2.1410,P＜0.05),and 11 QST threshold values of the somatoform disorders group were lower than those of control group,and the rate of steping down was higher than that of steping up(55%to 20%,x2=5.2267,P＜0.05).The Level method showed that the threshold values was significantly different in two groups,except the CS of right lower limb(RF-WT:1.07 ±0.13 1.33±0.03,t=8.5327,P＜0.01,LF-CS:28.73±0.69 28.08±0.63 t=3.2587,P＜0.01),and 8 QST threshold values of the somatoform disorders group were lower than those of control group,and the rate of steping down was higher than that of steping up(67%to 20%,x2=4.1958,P＜0.05).The rates of cutting down and stepping up were There were no significant deviation on the rates of cutting down or stepping up in both methods(P＞0.05).Conclusion Both Limit and Level show that the QST threshold values of the somatoform disorders step down,and it was more sensitivity in the somatoform disorders.The sensory disturbance generating from the somatoform disorders was related to the higher sensitivity in periphery nerve and central nerve.