下肢末梢神経障害に対する温泉療法の適応の検討

We observed peripheral circulation in patients suffering from peripheral neuropathy in order to quantify the effect of spa therapy on peripheral neuropathy.<br>The peripheral circulation was observed using thermography and Laser-Doppler blood flowmetry. Thirteen patients with a mean age of 71.9 years (range of 59-82) suffering from diabetic neuropathy with coldness, numbness, neuralgia in their feet or walk disturbance, and 11 patients with a mean age of 72.3 years (range of 60-84) suffering from lumbago, were examined by the methods. The blood flow, mass and velocity were measured by a Laser-Doppler blood flowmetry, after pre-loading with hot water at 36°C for 5min (hot loading), and after cold loading with cold water at 20°C for 5min. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio=[Total counts of thermography (Pixels) over 27°C after cold loading] ÷ [Initial counts over 27°C after hot loading]×100 (%).<br>The recovery ratio in diabetes mellitus was between 0-93.5% (mean=46.8%), whereas the recovery ratio in lumbago was between 0-91.3% (mean=41.3%). The blood flow in patients with diabetes mellitus was 1.11-5.36 (ml/min/100g tissue), (mean=2.44), the blood mass was 85-255 (mean=155), and the velocity was 0.447-0.784 (mean=0.591). The blood flow in patients with lumbago was 1.18-3.82, (mean=2.19), the blood mass was 89-195 (mean=144), and the velocity was 0.464-0.8 (mean=0.615). The recovery ratio and blood flow in patients with diabetes mellitus were correlated, r=0.62 and p<0.0002, as the recovery ratio and blood mass were correlated, r=0.59 and p<0.0001. However the blood flow and the velocity in these patients were not correlated, r=0.11. The recovery ratio and blood flow in patients with lumbago were not correlated, r=0.02, but the recovery ratio and blood mass showed some correlation, r=0.38. The recovery ratio and the velocity in these patients were correlated, r=0.64 and p<0.005. The blood flow in patients with diabetes mellitus was greater after hot loading (mean=2.89) than after cold loading (mean=2.44). The blood mass in patients with diabetes mellitus was greater after hot loading (mean=180) than after cold loading (mean=155). However, there was no significant change in the velocity after hot loading (mean=0.572) compared with the velocity after cold loading (mean=0.591).<br>It was revealed that patients with diabetes mellitus with low recovery ratios in thermography had low blood flow and blood mass in their peripheral circulation. Patients suffering from lumbago had different peripheral circulation compared with diabetes mellitus. Spa therapy was effective on diabetic peripheral neuropathy as the peripheral circulation improved with hot water at 36°C