摘要
目的研究胸交感神经调制对原发性手汗症患者的治疗效果以及术后交感神经兴奋水平和T淋巴细胞亚群的影响。方法选择2014年7月—2015年9月在嘉兴市第一医院初次行胸交感神经调制术的原发性手汗症患者40例(P组)和门诊同期健康体检者30例(C组)。P组分别于T0(术前)、T1(术后10 min)、T2(术后24 h)、T3(术后48 h)、T4(术后72 h)时刻抽取患者静脉血,C组在T0时刻抽取静脉血送检,检测血皮质醇、肾上腺素、去甲肾上腺素的水平和T淋巴细胞亚群的细胞百分比,并计算CD4^+/CD8^+的比值。结果 P组患者术后(T1)双手末梢灌注指数上升了(8.70±1.10)倍,双手温度平均上升了(2.92±0.86)℃,且双手多汗症状完全消失。所有患者疗效均能持续6个月以上,1年内复发率为7.50%(3/40),无严重并发症发生。与P组T0时刻比较,血皮质醇、肾上腺素、去甲肾上腺素的水平在T1、T2、T3、T4时刻均降低,差异有统计学意义(P<0.05);C组T0时刻血皮质醇、肾上腺素、去甲肾上腺素的水平无明显变化(P>0.05)。与P组T0时刻比较,CD3^+、CD4^+和CD4^+/CD8^+在T1、T2、T3、T4时刻升高,CD8^+的水平降低,差异有统计学意义(P<0.05);C组T0时刻的CD3^+、CD4^+、CD8^+和CD4^+/CD8^+的水平无明显变化(P>0.05)。结论胸交感神经调制可安全、有效地治疗原发性手汗症,并可降低患者术后的交感神经兴奋水平,提高患者的细胞免疫功能。
Objective To investigate the effects of thoracic sympathetic modulation on the therapy efficacy,postoperativesympathetic arousal level and T lymphocyte subsets in patients with primary palmar hyperhidrosis. Methods From July2014 to September 2015,40 patients with primary palmar hyperhidrosis who were prepared for thoracic thoracic sympathectomy（ Group P） and 30 outpatient healthy volunteers（ Group C） were recruited in the First Hospital of Jiaxing. The venous blood samples were prepared before the operation（ T0）,10 minutes,24 h,48 h,72 h after the operation（ T1,T2,T3,T4） at Group P,while before the operation（ T0） at Group C,for determination of plasma cortisol,epinephrine,norepinephrine,T-lymphocyte subsets and CD4＋/ CD8＋ratio. Results In group P,Oximetry-derived perfusion index raised（8. 70 ± 1. 10） times and the average temperature of hands raised（2. 92 ± 0. 86）℃ times,and the symptoms of hyperhidrosis disappeared in both hands. All of the patients with palmar hyperhidrosis were cured within 6 months,and the recurrence rate within 1 year was 7. 5%（3 /40）. There was no severe complication. Theplasma levels of cortisol,epinephrine and norepinephrine at T1,T2,T3 and T4 were significantly decreased after the treatment in the group P（ P〈0. 05）,but not in the group C（ P〈0. 05）. CD3＋,CD4＋and CD4＋/ CD8＋at T1,T2,T3 and T4 were significantly increased,while CD8＋significantly decreased after the treatment in the group P（ P〈0. 05）,but not in the group C（ P〈0. 05）. Conclusion Thoracic sympathetic modulation may reduce postoperativesympathetic arousal and improve cellular immune function of patients.
出处
《中华全科医学》
2016年第4期520-523,共4页
Chinese Journal of General Practice
基金
国家自然科学基金(81341035)
浙江省自然科学基金(L Y16H090016)
浙江省嘉兴市科技局基金(2015C23012)
浙江省中西医结合疼痛医学重点学科建设资助项目(2012-XK-A31)
浙江省卫生高层次创新人才培养工程项目(2012-RC-22)
浙北区域专病中心
嘉兴市疼痛医学重点科技创新团队项目(2011-CX-02)
关键词
胸交感神经
调制
原发性手汗症
交感神经兴奋水平
T淋巴细胞亚群
Thoracic sympathetic nerves
Thoracic sympathectomy
Primary palmar hyperhidrosis
Sympathetic arousal level
T-lymphocyte subsets
