振動障害患者における交感神経‐副腎髄質系機能と副腎皮質機能 寒冷負荷による血しょう尿中カテコラミン，血しょうコルチゾルの変動

Abstract

Much discussion has been made as to whether vibration syndrome is a peripheral or systemic disorder. We studied plasma and urine norepinephrine and epinephrine, and plasma cortisol under resting and cold exposure conditions (7 degrees C cold room for 30 min). The subjects were 20 patients with vibration syndrome and with a history of Raynaud's phenomenon, 20 patients with vibration syndrome without a history of Raynaud's phenomenon, and 20 healthy controls. They were all males and the three groups were matched by age. The following results were obtained. 1. Mean temperatures of finger skin in the patient groups under resting and cold exposure conditions were lower than in the control group. Mean systolic and diastolic blood pressures in the patient groups under both conditions were higher than in the control group. Mean values of blood pressure change produced by cold exposure in the patient groups were lower than in the control group. Some of these differences were statistically significant (p less than 0.05 or p less than 0.01). 2. Mean levels of plasma norepinephrine in the patient groups under resting and cold exposure conditions were significantly higher (p less than 0.01 or p less than 0.05) than in the control group. This finding indicates that the patients with vibration syndrome had hyperfunction of the sympathetic nervous system. Mean levels of urine norepinephrine in the patient groups were not significantly different from the control group. 3. Mean levels of plasma epinephrine in the patient groups under resting and cold exposure conditions were lower than in the control group. The differences between the patient groups and the control group were significant (p less than 0.05 or p less than 0.01) in the cold exposure condition. This finding suggests that the patients with vibration syndrome had hypofunction of the adrenomedullar system. Urine epinephrine in the patient groups was not significantly different from the control group. 4. Mean levels of cortisol in the patient groups were higher than in the control group. The difference in cortisol level between the group of patients without Raynaud's phenomenon and the control group was significant (p less than 0.01) in the resting condition. This finding may suggest that the patients with vibration syndrome had hyperfunction of the adrenocortex. The foregoing data support the hypothesis that vibration syndrome is a systemic dysfunction, which includes disorders of the sympathetic-adrenomedullar system and adrenocortex.