定量感觉检查在周围神经病中的应用
摘要
背景与目的
定量感觉检查（Quantitive Sensor Testing, QST）是对感觉进行定量判断的一种心理物理学技术，它可以对感觉障碍的程度进行定量评价，是近年来发展较快的的一门技术。QST代替了传统的用大头针、棉签等检查来评价感觉神经功能，相对与传统的方法较客观、可比性好。周围神经由有髓鞘的大神经纤维（A(纤维）和薄髓鞘的小神经纤维（Aδ纤维）以及无髓鞘的小纤维（C纤维）组成。A(纤维感受粗触觉、压力觉和关节位置觉等。Aδ纤维传导冷觉、快痛觉，组成自主神经节前纤维；C纤维传导热觉、感受各种伤害性刺激和传导慢痛觉，组成自主神经节后纤维。 QST是唯一能评估小神经纤维有无受损的方法，它可反应整个感觉传导通路的功能。作QST检查时患者无痛苦体验，且操作容易，用于长期随访感觉神经功能易被患者接受。
定量感觉检查包括定量温度觉、定量振动觉、定量触觉、最小电流阈值法（CPT）和定量自主神经检查等多种方法，分别检查不同直径的神经纤维的功能。
自从1976年Fruhstrofer发表第一篇关于QST的文章以来，QST已被广泛地应用于临床、科研中。1992年美国罗切斯特周围神经疾病中心将QST作为诊断糖尿病周围神经病变的五个条件之一。QST在判断糖尿病患者的感觉神经是否有受损、评估神经受损的严重程度、长期随访观察治疗效果等方面发挥了较大的作用；在疼痛的评估、中毒性神经病、感
染性神经病、自主神经功能障碍等方面也研究较多。其的重复性和敏感性均较高。国内在这方面的研究起步较晚，1998年国内毛思中最早将定量感觉应用于临床，她分析了正常人定量感觉检查的特点以及糖尿病、吉兰-巴雷综合征及周围神经病患者的定量感觉特点，认为可把定量感觉结果的异常作为早期诊断糖尿病周围神经病的指标之一。以后陈大伟等用定量感觉分析仪检查了带状疱疹后神经痛患者的温度觉阈值变化规律并探讨了神经痛的机理。但定量感觉检查的应用远非这些。
本文的研究目的：拟通过研究某些特定人群定量感觉检查的特点，扩大QST在临床上的应用价值。
方法
应用定量感觉分析仪测定正常老年人、焦虑症、慢性酒精中毒、抗痨治疗、坐骨神经痛、面神经麻痹等特殊患者的冷觉、热觉、冷痛觉、热痛觉和振动觉的特点及分析影响因素，探讨可能的机制。全文分六个独立部分。
1. 研究老年人的定量感觉特点（重复性）及影响因素，探讨QST是否可作为检查老年人周围神经病常用的方法。选择正常老年人50人，中青年30人用定量感觉分析仪在三个不同时间分别测定左上肢的大鱼际区、食指，左下肢足背外侧缘、左第一足趾的皮肤的冷觉、冷痛觉、热觉、热痛觉和左食指第一指骨、左第一足趾的振动觉。比较三次结果有无不同，与中青年组比较有无不同，分析既往从事的职业、文化程度对QST的影响。
2. 研究焦虑症患者定量感觉检查的特点，与糖尿病患者比较有无不同以及抗焦虑治疗对QST的影响。选择有主观感觉障碍的焦虑症患者
30例、糖尿病患者20例和正常对照46例，分别测定各组双大鱼际肌、双足背的冷觉、冷痛觉、热觉、热痛觉阈值，比较三组QST结果有无显著性差异。焦虑症组抗焦虑治疗一月后随访QST，治疗前后比较QST有无显著性差异。
3. 研究酒精中毒患者的定量感觉特点，分析是否可作为早期提示神经损伤的指标。选择长期饮酒每天250mL以上白酒的患者（饮酒时间>5年）40例，与之年龄相匹配的正常人30例，分别作左小鱼际区、左食指、左足背外侧、左第一足趾皮区的温度觉及左食指、左第一足趾的振动觉阈值和左胫神经、左正中神经、尺神经的的感觉、运动传导速度等检查。
4. 用QST研究大剂量异烟肼的神经毒性及维生素B6的干预作用。选择结核性脑膜炎患者30例，随机分成两组，一组接受大剂量异烟肼治疗的同时接受维生素B6治疗，另一组只接受大剂量异烟肼治疗，如后一组治疗时患者诉肢体感觉麻木，加用维生素B6治疗。两组分别于治疗后2~3周内、治疗后1月、2月、半年随访定量感觉结果，记录有无感觉麻木、疼痛等异常感觉。
5. 研究腰椎间盘突出症所致坐骨神经痛患者的定量感觉特点，分析定量感觉的异常是否与腰椎间盘突出程度有关，探讨能否把QST异常作为选择手术治疗的指标之一。选择20例由腰椎间盘突出所致坐骨神经痛发作的患者，分别测定患者左右两侧小腿外侧和足背外缘的皮肤的温度觉和外踝的振动觉，并同时测定患侧的胫神经感觉传导速度和H反射。
6. 研究面神经麻痹患者的定量温度觉特点，分析定量感觉异常的影响因素（与病因的关系）和预后的关系。评价QST是否可以作为判断面瘫预后的指标。选择周围性面瘫患者30例，测定三叉神经第一、第二
支分布区域皮肤的定量感觉。
结果
1. 三次结果比较无显著性差异，P>0.05，提示QST的可重复性较好，上肢的温度觉、震动觉阈值低于下肢。职业和文化程度对QST的影响较小，老年组五种类型的感觉阈值高于中青年组，P<0.05，且QST的变异系数较中青年组大。
2. 焦虑症患者的感觉阈值低于糖尿病患者及正常对照组。抗焦虑治疗后感觉阈值有所增高，P<0.05。
3.长期饮酒患者五种感觉阈值与正常人比较均有增高，P<0.05。异?
Background and Objective
Quantitative Sensory Testing (QST) is a innovative psychophysical technology to quantitatively determine the sensory of patients, can evaluate the sensory disturbance quantitatively. It is now two decades since the publication of the first clinical paper on the use of quantitative sensory testing disorders (Fruhstrofer et al., 1976), and the field has seen a flurry of subsequent publications. As the reader will note, most clinical situations which affect sensory function have been investigated by means of QST. In most instances, the data is predominantly descriptive, consisting primarily of abnormality rates for various modalities of sensation. Yet, in the major disorders of sensation, such as those associated with Diabetes mellitus, QST research has gone far beyond basic description. Here the use of QST in the clinic is much better defined, including its role in diagnosis, staging, longterm follow-up of the natural history of disease, and determination of treatment efficacy. Data is also available regarding the relative role of QST versus other parameters of neural function, such as electro-physiological and autonomic testing.
Testing thermal and vibration modalities enables assessment of the different types of sensory fibres. Vibration stimuli, peripherally, activate large
myelinated fibres (A() and centrally, the dorsal columns. For the thermal senses, peripherally, cold sensation is mediated by small myelinated fibres (A(); warm sensation by unmyelinated warm specific C-fibres; heat-pain by small myelinated and unmyelinated nociceptors and cold pain—both types of thermal stimuli (nonpain and painful) activate the spinoreticulothalamic tracts.
Sensory threshold measures are the most commonly employed QST parameter. Being psychophysical responses, QST parameters are very sensitive to different methodological aspects of the test, thus, considerable attention must to paid these details in order to obtain valid and reproducible results. Many studies, particularly when the technique was initially introduced, did not follow strict experimental protocols. As a result, contradictory findings may be encountered in the literature. Additional methodological issues, important in threshold determination, include site of testing, pressure of stimulator application, stimulator size and subject training. QST was applied clinically in pain assessment, metabolic neuropathies, toxic neuropathies, acquired diseases, autonomic failure, occupational medicine and evaluation of medications.Mao si zhong applied QST in clinic in 1998 in china. She evaluated the application of QST to diabetic peripheral neuropathy, Guillain Barre syndrome and polyneuropathy. She consided QST was a sensitive method for diagnosis of diabetic neuropathy. Chen da wei used thermal quantitative testing to identiy whether or not there are sensory deficits in postherpetic neuralgia (PHN) patients and obtain information about the magnitude of thermal sensory deficits and its relationship with the painful intensity in PHN patients, and discussed multi-mechanisms in different PHN patients.
Objective: Experimentally investigate the QST characteristic of special crowd, to extend the usage of QST.
Methods
Used TSA-II (Thermal Sensory Analyzer) tested the cold sensation, warm sensation, cold pain and heat pain plus to sensation of viberation for the health elders and patients with disorders such as anxiety neurosis, chronic alcoholism, tuberculosis treatment, sciatica, peripheral facial paralysis, and analysed the contributing factors and discussed the probable mechanism of those phenomena.
There are six main parts: 1. Investigated the QST characteristic of elders and discussed the determinate contributing factors, to determine the feasibility of using QST methods in diagnosing the peripheral neuropathy of elders. 2. Investigated the QST characteristic of patients of anxiety neurosis, compared with the characteristic of diabetes patients, and then gave the effect of anti- anxiety neurosis t
定量感觉检查（Quantitive Sensor Testing, QST）是对感觉进行定量判断的一种心理物理学技术，它可以对感觉障碍的程度进行定量评价，是近年来发展较快的的一门技术。QST代替了传统的用大头针、棉签等检查来评价感觉神经功能，相对与传统的方法较客观、可比性好。周围神经由有髓鞘的大神经纤维（A(纤维）和薄髓鞘的小神经纤维（Aδ纤维）以及无髓鞘的小纤维（C纤维）组成。A(纤维感受粗触觉、压力觉和关节位置觉等。Aδ纤维传导冷觉、快痛觉，组成自主神经节前纤维；C纤维传导热觉、感受各种伤害性刺激和传导慢痛觉，组成自主神经节后纤维。 QST是唯一能评估小神经纤维有无受损的方法，它可反应整个感觉传导通路的功能。作QST检查时患者无痛苦体验，且操作容易，用于长期随访感觉神经功能易被患者接受。
定量感觉检查包括定量温度觉、定量振动觉、定量触觉、最小电流阈值法（CPT）和定量自主神经检查等多种方法，分别检查不同直径的神经纤维的功能。
自从1976年Fruhstrofer发表第一篇关于QST的文章以来，QST已被广泛地应用于临床、科研中。1992年美国罗切斯特周围神经疾病中心将QST作为诊断糖尿病周围神经病变的五个条件之一。QST在判断糖尿病患者的感觉神经是否有受损、评估神经受损的严重程度、长期随访观察治疗效果等方面发挥了较大的作用；在疼痛的评估、中毒性神经病、感
染性神经病、自主神经功能障碍等方面也研究较多。其的重复性和敏感性均较高。国内在这方面的研究起步较晚，1998年国内毛思中最早将定量感觉应用于临床，她分析了正常人定量感觉检查的特点以及糖尿病、吉兰-巴雷综合征及周围神经病患者的定量感觉特点，认为可把定量感觉结果的异常作为早期诊断糖尿病周围神经病的指标之一。以后陈大伟等用定量感觉分析仪检查了带状疱疹后神经痛患者的温度觉阈值变化规律并探讨了神经痛的机理。但定量感觉检查的应用远非这些。
本文的研究目的：拟通过研究某些特定人群定量感觉检查的特点，扩大QST在临床上的应用价值。
方法
应用定量感觉分析仪测定正常老年人、焦虑症、慢性酒精中毒、抗痨治疗、坐骨神经痛、面神经麻痹等特殊患者的冷觉、热觉、冷痛觉、热痛觉和振动觉的特点及分析影响因素，探讨可能的机制。全文分六个独立部分。
1. 研究老年人的定量感觉特点（重复性）及影响因素，探讨QST是否可作为检查老年人周围神经病常用的方法。选择正常老年人50人，中青年30人用定量感觉分析仪在三个不同时间分别测定左上肢的大鱼际区、食指，左下肢足背外侧缘、左第一足趾的皮肤的冷觉、冷痛觉、热觉、热痛觉和左食指第一指骨、左第一足趾的振动觉。比较三次结果有无不同，与中青年组比较有无不同，分析既往从事的职业、文化程度对QST的影响。
2. 研究焦虑症患者定量感觉检查的特点，与糖尿病患者比较有无不同以及抗焦虑治疗对QST的影响。选择有主观感觉障碍的焦虑症患者
30例、糖尿病患者20例和正常对照46例，分别测定各组双大鱼际肌、双足背的冷觉、冷痛觉、热觉、热痛觉阈值，比较三组QST结果有无显著性差异。焦虑症组抗焦虑治疗一月后随访QST，治疗前后比较QST有无显著性差异。
3. 研究酒精中毒患者的定量感觉特点，分析是否可作为早期提示神经损伤的指标。选择长期饮酒每天250mL以上白酒的患者（饮酒时间>5年）40例，与之年龄相匹配的正常人30例，分别作左小鱼际区、左食指、左足背外侧、左第一足趾皮区的温度觉及左食指、左第一足趾的振动觉阈值和左胫神经、左正中神经、尺神经的的感觉、运动传导速度等检查。
4. 用QST研究大剂量异烟肼的神经毒性及维生素B6的干预作用。选择结核性脑膜炎患者30例，随机分成两组，一组接受大剂量异烟肼治疗的同时接受维生素B6治疗，另一组只接受大剂量异烟肼治疗，如后一组治疗时患者诉肢体感觉麻木，加用维生素B6治疗。两组分别于治疗后2~3周内、治疗后1月、2月、半年随访定量感觉结果，记录有无感觉麻木、疼痛等异常感觉。
5. 研究腰椎间盘突出症所致坐骨神经痛患者的定量感觉特点，分析定量感觉的异常是否与腰椎间盘突出程度有关，探讨能否把QST异常作为选择手术治疗的指标之一。选择20例由腰椎间盘突出所致坐骨神经痛发作的患者，分别测定患者左右两侧小腿外侧和足背外缘的皮肤的温度觉和外踝的振动觉，并同时测定患侧的胫神经感觉传导速度和H反射。
6. 研究面神经麻痹患者的定量温度觉特点，分析定量感觉异常的影响因素（与病因的关系）和预后的关系。评价QST是否可以作为判断面瘫预后的指标。选择周围性面瘫患者30例，测定三叉神经第一、第二
支分布区域皮肤的定量感觉。
结果
1. 三次结果比较无显著性差异，P>0.05，提示QST的可重复性较好，上肢的温度觉、震动觉阈值低于下肢。职业和文化程度对QST的影响较小，老年组五种类型的感觉阈值高于中青年组，P<0.05，且QST的变异系数较中青年组大。
2. 焦虑症患者的感觉阈值低于糖尿病患者及正常对照组。抗焦虑治疗后感觉阈值有所增高，P<0.05。
3.长期饮酒患者五种感觉阈值与正常人比较均有增高，P<0.05。异?
Background and Objective
Quantitative Sensory Testing (QST) is a innovative psychophysical technology to quantitatively determine the sensory of patients, can evaluate the sensory disturbance quantitatively. It is now two decades since the publication of the first clinical paper on the use of quantitative sensory testing disorders (Fruhstrofer et al., 1976), and the field has seen a flurry of subsequent publications. As the reader will note, most clinical situations which affect sensory function have been investigated by means of QST. In most instances, the data is predominantly descriptive, consisting primarily of abnormality rates for various modalities of sensation. Yet, in the major disorders of sensation, such as those associated with Diabetes mellitus, QST research has gone far beyond basic description. Here the use of QST in the clinic is much better defined, including its role in diagnosis, staging, longterm follow-up of the natural history of disease, and determination of treatment efficacy. Data is also available regarding the relative role of QST versus other parameters of neural function, such as electro-physiological and autonomic testing.
Testing thermal and vibration modalities enables assessment of the different types of sensory fibres. Vibration stimuli, peripherally, activate large
myelinated fibres (A() and centrally, the dorsal columns. For the thermal senses, peripherally, cold sensation is mediated by small myelinated fibres (A(); warm sensation by unmyelinated warm specific C-fibres; heat-pain by small myelinated and unmyelinated nociceptors and cold pain—both types of thermal stimuli (nonpain and painful) activate the spinoreticulothalamic tracts.
Sensory threshold measures are the most commonly employed QST parameter. Being psychophysical responses, QST parameters are very sensitive to different methodological aspects of the test, thus, considerable attention must to paid these details in order to obtain valid and reproducible results. Many studies, particularly when the technique was initially introduced, did not follow strict experimental protocols. As a result, contradictory findings may be encountered in the literature. Additional methodological issues, important in threshold determination, include site of testing, pressure of stimulator application, stimulator size and subject training. QST was applied clinically in pain assessment, metabolic neuropathies, toxic neuropathies, acquired diseases, autonomic failure, occupational medicine and evaluation of medications.Mao si zhong applied QST in clinic in 1998 in china. She evaluated the application of QST to diabetic peripheral neuropathy, Guillain Barre syndrome and polyneuropathy. She consided QST was a sensitive method for diagnosis of diabetic neuropathy. Chen da wei used thermal quantitative testing to identiy whether or not there are sensory deficits in postherpetic neuralgia (PHN) patients and obtain information about the magnitude of thermal sensory deficits and its relationship with the painful intensity in PHN patients, and discussed multi-mechanisms in different PHN patients.
Objective: Experimentally investigate the QST characteristic of special crowd, to extend the usage of QST.
Methods
Used TSA-II (Thermal Sensory Analyzer) tested the cold sensation, warm sensation, cold pain and heat pain plus to sensation of viberation for the health elders and patients with disorders such as anxiety neurosis, chronic alcoholism, tuberculosis treatment, sciatica, peripheral facial paralysis, and analysed the contributing factors and discussed the probable mechanism of those phenomena.
There are six main parts: 1. Investigated the QST characteristic of elders and discussed the determinate contributing factors, to determine the feasibility of using QST methods in diagnosing the peripheral neuropathy of elders. 2. Investigated the QST characteristic of patients of anxiety neurosis, compared with the characteristic of diabetes patients, and then gave the effect of anti- anxiety neurosis t
引文
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Carey LM;Matyas TA;Oke LE ,Evaluation of impaired fingertip texture discrimination and wrist position sense in patients affected by stroke: comparison of clinical and new quantitative measures. J Hand Ther 2002
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Hilz MJ; Axelrod FB Quantitative sensory testing of thermal and vibratory perception in familial dysautonomia. Clin Auton Res 2000 Aug;10(4):177-83??
Hecht MJ; Neundorfer B; Kiesewetter F; et al., Neuropathy is a major contributing factor to diabetic erectile dysfunction. Neurol Res 2001 Sep;23(6):651-4?
Leocani L; Martinelli V; Natali-Sora MG; et al., Somatosensory evoked potentials and sensory involvement in multiple sclerosis: comparison with clinical findings and quantitative sensory tests Mult Scler 2003 Jun;9(3):275-9 ?
Desmeules JA; Cedraschi C; Rapiti E; et al., Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum 2003 May;48(5):1420-9?
Freeman R; Chase KP; Risk MR Quantitative sensory testing cannot differentiate simulated sensory loss from sensory neuropathy. Neurology 2003 Feb 11;60(3):465-70?
Poncelet AN; Connolly MK ,Peripheral neuropathy in scleroderma Muscle Nerve 2003 Sep;28(3):330-5
Von Giesen HJ; Weiss P; Arendt G; et al., Potential c-fiber damage in Wilson's disease Acta Neurol Scand 2003 Oct;108(4):257-61
毛思中，董为伟，正常人的温度觉、震动觉定量测定，中华神经科杂志，1999，32（4）256
毛思中，董为伟，吉兰-巴雷综合征和多发性神经病患者的温度觉和震动觉定量测定，中国神经精神疾病杂志2001，27（2）112-115
陈大伟，谢鹏，邹德智等，带状疱疹后遗神经痛患者的感觉定量测定，临床神经电生理学杂志，2003，12（1），16~8
Meier PM; Berde CB; Di Canzio J; et al., Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents. Muscle Nerve 2001 Oct;24(10):1339-45?
Hilz, M., Glorius, S.E., Schweibold, G., et al., Quantitative thermal perception testing in preschool children. Muscle and Nerve 1996. 19, 381–383.
Meier PM; Berde CB; Di Canzio J; et al., Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents Muscle Nerve 2001 ;24(10):1339-45?
AlShekhlee, A, Chelimsky ,TC, Preston DC, Review:small-fiber neuropathy .The Neurologist 8:237-253,2002
Claus, D., Hilz, M.J., Neundorfer, B., Thermal discrimination thresholds: a comparison of different methods. Acta Neurol. Scand. 1990.81 (6), 533–540.
Yarnitsky, D., Quantitative sensory testing. Muscle and Nerve 1997.20, 198–204.
McArthur JC, Stocks EA, Hauer P, et al., Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol. 1998;55:1513-1520.
Chang YC, Lin WM ,Hsieh ST, Effects of aging on human skin innervation, Clinical Neuroscience and Neuropathology, 2004, 15(1):149-153
McManis P G, Windebank A J, Kiziltan M. Neuropathy associated with hyperlipidemia . Neuropathy .1994;44:2185-2186.
Young MJ, Boulton AJM, MacLeod AF, et al., A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36:1-5.
贾志容，石昕，黄一宁等，皮肤交感反应在糖尿病周围神经病早期诊断中的价值，中华神经科杂志，2003，3（36），188-190
Falck-Ytter Y; McCullough AJ; Nutritional effects of alcoholism. Curr Gastroenterol Rep 2000;2(4):331-6
Monforte R; Estruch R; Valls-Sole J; et al., Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol 1995 Jan;52(1):45-51
Hilz, M.J., Claus, D., Neundorfer, B., et al., Is heat hypoalgesia a useful parameter in quantitative thermal testing of alcoholic polyneuropathy? Muscle Nerve1994. 17 (12), 1456–1460.
Sosenko, J.M., Soto, R., Aronson, J., et al., The prevalence and extent of vibration sensitivity impairment in men with chronic ethanol abuse. J. Stud. Alcohol 1991. 52 (4), 374–376.
丛志强, 结核性脑膜炎的治疗进展 ,中国实用内科杂志,1997, 17,(5)301-2
Lan NTN; Lademarco MF; Binkin NJ; et al., A case series: initial outcome of persons with multidrug-resistant tuberculosis after treatment with the WHO standard retreatment regimen in, Int J Tuberc Lung Dis 2001 Jun;5(6):575-8
Volmink J; Garner P, Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 2003;(1):CD003343?
Chan ED; Iseman MD, Current medical treatment for tuberculosis. BMJ 2002 Nov 30;325(7375):1282-6
Schifitto, G. Yiannoutsos C ;. Simpson ,D.M, et al., Long-term treatment with recombinant nerve growth factor for HIV-associated sensory neuropathy Neurology 2001;57:1313–1316
Blum, A.S.; DalPan, G.J.; Feinberg, J.; et al., Low-dose zalcitabine-related toxic neuropathy: Frequency, natural history, and risk factors. Neurology 1996;46: 999-1003.
梅芳瑞,张峡,李长青, 腰椎间盘突出症的非手术治疗(40例前瞻性研究), 颈腰痛杂志1999,20(3),165-7
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Garfin SR, Rvdevik BL, Brown RA, et al.,Compressive neuropathy of spinal nerve roots a mechanical or biological problem? Spine 1991;16:162-6
Vad VB, Bhat AL, Lutz GE, et al.,Transforaminal epidural steroid injections lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27:11-6
Strian, F., Lautenbacher, S., Karlbauer, G., et al., Disturbances of C-fibre-mediated sensibility in lumbosacral disc disease. J. Neurol. Neurosurg. Psych. 1991. 54, 1013–1014.
Nygaard OP; Kloster R; Solberg T; et al., Recovery of function in adjacent nerve roots after surgery for lumbar disc herniation: use of quantitative sensory testing in the exploration of different populations of nerve fibers. J Spinal Disord 2000;13(5):427-31
Mosek A ,Yarnitsky D, Korczyn AD , et al., The assessment of radiating low back pain by thermal sensory testing. Eur J Pain 2001; 5:347-51
Zwart JA, Sand T, Unsgaard G. Warm and cold thresholds in patients with unilateral sciatica: C-fibers re more severely affected than A-delta fibers: Acta Neurol Scand 1998;97:41-5
赵荣祥，魏炯渊，面瘫预后指标探讨，中国中西医结合耳鼻喉科杂志，2001，（4）163-5
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Carey LM;Matyas TA;Oke LE ,Evaluation of impaired fingertip texture discrimination and wrist position sense in patients affected by stroke: comparison of clinical and new quantitative measures. J Hand Ther 2002
Hurtig IM; Gerdle B; Wahren LK Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups. Clin J Pain 2001 Dec;17(4):316-22?
Hilz MJ; Axelrod FB Quantitative sensory testing of thermal and vibratory perception in familial dysautonomia. Clin Auton Res 2000 Aug;10(4):177-83??
Hecht MJ; Neundorfer B; Kiesewetter F; et al., Neuropathy is a major contributing factor to diabetic erectile dysfunction. Neurol Res 2001 Sep;23(6):651-4?
Leocani L; Martinelli V; Natali-Sora MG; et al., Somatosensory evoked potentials and sensory involvement in multiple sclerosis: comparison with clinical findings and quantitative sensory tests Mult Scler 2003 Jun;9(3):275-9 ?
Desmeules JA; Cedraschi C; Rapiti E; et al., Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum 2003 May;48(5):1420-9?
Freeman R; Chase KP; Risk MR Quantitative sensory testing cannot differentiate simulated sensory loss from sensory neuropathy. Neurology 2003 Feb 11;60(3):465-70?
Poncelet AN; Connolly MK ,Peripheral neuropathy in scleroderma Muscle Nerve 2003 Sep;28(3):330-5
Von Giesen HJ; Weiss P; Arendt G; et al., Potential c-fiber damage in Wilson's disease Acta Neurol Scand 2003 Oct;108(4):257-61
毛思中，董为伟，正常人的温度觉、震动觉定量测定，中华神经科杂志，1999，32（4）256
毛思中，董为伟，吉兰-巴雷综合征和多发性神经病患者的温度觉和震动觉定量测定，中国神经精神疾病杂志2001，27（2）112-115
陈大伟，谢鹏，邹德智等，带状疱疹后遗神经痛患者的感觉定量测定，临床神经电生理学杂志，2003，12（1），16~8
Meier PM; Berde CB; Di Canzio J; et al., Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents. Muscle Nerve 2001 Oct;24(10):1339-45?
Hilz, M., Glorius, S.E., Schweibold, G., et al., Quantitative thermal perception testing in preschool children. Muscle and Nerve 1996. 19, 381–383.
Meier PM; Berde CB; Di Canzio J; et al., Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents Muscle Nerve 2001 ;24(10):1339-45?
AlShekhlee, A, Chelimsky ,TC, Preston DC, Review:small-fiber neuropathy .The Neurologist 8:237-253,2002
Claus, D., Hilz, M.J., Neundorfer, B., Thermal discrimination thresholds: a comparison of different methods. Acta Neurol. Scand. 1990.81 (6), 533–540.
Yarnitsky, D., Quantitative sensory testing. Muscle and Nerve 1997.20, 198–204.
McArthur JC, Stocks EA, Hauer P, et al., Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol. 1998;55:1513-1520.
Chang YC, Lin WM ,Hsieh ST, Effects of aging on human skin innervation, Clinical Neuroscience and Neuropathology, 2004, 15(1):149-153
McManis P G, Windebank A J, Kiziltan M. Neuropathy associated with hyperlipidemia . Neuropathy .1994;44:2185-2186.
Young MJ, Boulton AJM, MacLeod AF, et al., A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36:1-5.
贾志容，石昕，黄一宁等，皮肤交感反应在糖尿病周围神经病早期诊断中的价值，中华神经科杂志，2003，3（36），188-190
Falck-Ytter Y; McCullough AJ; Nutritional effects of alcoholism. Curr Gastroenterol Rep 2000;2(4):331-6
Monforte R; Estruch R; Valls-Sole J; et al., Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol 1995 Jan;52(1):45-51
Hilz, M.J., Claus, D., Neundorfer, B., et al., Is heat hypoalgesia a useful parameter in quantitative thermal testing of alcoholic polyneuropathy? Muscle Nerve1994. 17 (12), 1456–1460.
Sosenko, J.M., Soto, R., Aronson, J., et al., The prevalence and extent of vibration sensitivity impairment in men with chronic ethanol abuse. J. Stud. Alcohol 1991. 52 (4), 374–376.
丛志强, 结核性脑膜炎的治疗进展 ,中国实用内科杂志,1997, 17,(5)301-2
Lan NTN; Lademarco MF; Binkin NJ; et al., A case series: initial outcome of persons with multidrug-resistant tuberculosis after treatment with the WHO standard retreatment regimen in, Int J Tuberc Lung Dis 2001 Jun;5(6):575-8
Volmink J; Garner P, Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 2003;(1):CD003343?
Chan ED; Iseman MD, Current medical treatment for tuberculosis. BMJ 2002 Nov 30;325(7375):1282-6
Schifitto, G. Yiannoutsos C ;. Simpson ,D.M, et al., Long-term treatment with recombinant nerve growth factor for HIV-associated sensory neuropathy Neurology 2001;57:1313–1316
Blum, A.S.; DalPan, G.J.; Feinberg, J.; et al., Low-dose zalcitabine-related toxic neuropathy: Frequency, natural history, and risk factors. Neurology 1996;46: 999-1003.
梅芳瑞,张峡,李长青, 腰椎间盘突出症的非手术治疗(40例前瞻性研究), 颈腰痛杂志1999,20(3),165-7
Yoshizawa H, Kobayashi S, Morita T, Chronic nerve root compression. Spine 1995;20:379-407
Garfin SR, Rvdevik BL, Brown RA, et al.,Compressive neuropathy of spinal nerve roots a mechanical or biological problem? Spine 1991;16:162-6
Vad VB, Bhat AL, Lutz GE, et al.,Transforaminal epidural steroid injections lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27:11-6
Strian, F., Lautenbacher, S., Karlbauer, G., et al., Disturbances of C-fibre-mediated sensibility in lumbosacral disc disease. J. Neurol. Neurosurg. Psych. 1991. 54, 1013–1014.
Nygaard OP; Kloster R; Solberg T; et al., Recovery of function in adjacent nerve roots after surgery for lumbar disc herniation: use of quantitative sensory testing in the exploration of different populations of nerve fibers. J Spinal Disord 2000;13(5):427-31
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