Palmer Keith T, Griffin Michael J, Syddall Holly, Cooper Cyrus, Coggon David
MRC Environmental Epidemiology Unit, Community Clinical Sciences, University of Southampton, UK.
Int Arch Occup Environ Health. 2002 Jan;75(1-2):29-36. doi: 10.1007/s004200100275.
To investigate the association between functional difficulties in using the upper limb and extent and frequency of finger blanching, and the merits of these markers in grading the severity of Raynaud's phenomenon (RP) and vibration-induced white finger (VWF).
A questionnaire was mailed to a randomly selected community sample of 22,194 working-aged adults. Information was collected on cold-induced finger blanching--including the extent and frequency of attacks in the past year, and on difficulty in using the upper limb in several everyday activities (e.g. doing up buttons, opening a tight screwtop jar, and pouring from a jug). Associations were examined by logistic regression with the resultant odds ratios converted into prevalence ratios (PRs) and 95% confidence intervals (95% CI).
Among 12,907 respondents were 1,359 who reported finger blanching and provided details of its extent and frequency. Of these, 7.4% reported frequent attacks (50 or more over the year), and 12% reported extensive blanching (affecting nine or ten digits). After adjustment for potential confounders, subjects with finger blanching reported an excess of difficulties in using the limb. Thus, in men with blanching the PR for difficulty with buttons was 4.7 (95% CI 3.9-5.8), and that for pouring from a jug was 3.8 (3.0-4.9) in comparison with men who had never had blanching. Similar associations were found in women and in those men with exposure to hand-transmitted vibration. The risk of reporting difficulties increased markedly with frequency of blanching--up to four- or fivefold in those with 50 or more attacks in the past year compared with those who had none; but differences by extent were less marked, with PRs < or = 1.6 in those with nine to ten digits affected compared with one to two digits.
RP and VWF are both associated with difficulties in using the upper limb in everyday tasks. Further investigation of potential reporting biases is warranted, but if the associations are causal, frequency of attacks influences impairment more than extent of disease. More account may need to be taken of frequency of blanching episodes in assessing and in compensating subjects with VWF.
研究上肢功能障碍与手指变白的程度和频率之间的关联，以及这些指标在雷诺现象（RP）和振动性白指（VWF）严重程度分级中的价值。
向随机抽取的22194名工作年龄成年人的社区样本邮寄问卷。收集有关冷诱导手指变白的信息，包括过去一年发作的程度和频率，以及在几项日常活动（如扣纽扣、打开拧紧的螺旋盖罐子和从水壶倒水）中使用上肢的困难情况。通过逻辑回归分析关联性，并将所得比值比转换为患病率比（PRs）和95%置信区间（95%CI）。
在12907名受访者中，有1359人报告有手指变白情况，并提供了其程度和频率的详细信息。其中，7.4%报告发作频繁（一年50次或更多），12%报告变白范围广泛（影响九或十个手指）。在对潜在混杂因素进行调整后，有手指变白的受试者报告在使用肢体方面存在更多困难。因此，与从未有过手指变白的男性相比，有手指变白的男性扣纽扣困难的PR为4.7（95%CI 3.9 - 5.8），从水壶倒水困难的PR为3.8（3.0 - 4.9）。在女性以及接触手部传递振动的男性中也发现了类似的关联。报告困难的风险随着手指变白频率的增加而显著增加，与无发作的人相比，过去一年发作50次或更多的人风险增加高达四到五倍；但范围差异不太明显，与一到两个手指受影响的人相比，九到十个手指受影响的人的PRs≤1.6。
RP和VWF均与日常任务中使用上肢的困难有关。有必要进一步调查潜在的报告偏倚，但如果这些关联是因果关系，发作频率对损伤的影响大于疾病范围。在评估和补偿VWF患者时，可能需要更多地考虑手指变白发作的频率。
