Wollersheim H, Thien T
Department of Medicine, University Hospital Nijmegen.
Neth J Med. 1990 Dec;37(5-6):171-82.
Patients presenting with Raynaud's phenomenon pose differential diagnostic problems. The question is whether the discolorations are a symptom of the benign primary type or a symptom of an underlying disease, mostly a connective tissue disease or an atherosclerotic occlusive disease, both having major prognostic implications. To evaluate whether Raynaud patients can be classified properly in the above-mentioned categories on clinical grounds we evaluated 225 patients using a checklist dealing with signs and symptoms supposed to be specific for primary Raynaud's phenomenon or the two major types of the secondary form. Complaints that started before the age of 20, reactive hyperaemia at the end of an attack and discolorations of the earlobes and the nose have a high predictive value for primary Raynaud's phenomenon. Trophic skin disturbances are rare in the latter but are rather specific for connective tissue diseases. In the case of arterial obstructive disease, the feet are always involved and risk factors associated with atherosclerosis are often present, whereas this type is specifically encountered in men in whom the complaints started over the age of 50 [corrected], and in whom signs of atherosclerotic vessel wall disease were seen elsewhere. In conclusion, in most patients who present with a Raynaud's phenomenon a complete history and physical examination are sufficient for a correct diagnosis. Supplementation with determination of anti-nuclear antibodies, measurements of the capillary perfusion and of the finger skin systolic pressure completes the diagnostic classification.
出现雷诺现象的患者存在鉴别诊断问题。问题在于这些变色是良性原发性类型的症状，还是潜在疾病的症状，大多数情况下是结缔组织病或动脉粥样硬化闭塞性疾病，这两种疾病都具有重大的预后意义。为了评估能否基于临床依据将雷诺病患者正确分类到上述类别中，我们使用一份涉及体征和症状的清单对225例患者进行了评估，这些体征和症状被认为是原发性雷诺现象或两种主要继发性类型所特有的。20岁之前开始出现的症状、发作末期的反应性充血以及耳垂和鼻子的变色对原发性雷诺现象具有较高的预测价值。后者很少出现营养性皮肤障碍，但这对结缔组织病具有较高的特异性。在动脉阻塞性疾病的情况下，足部总是会受累，并且通常存在与动脉粥样硬化相关的危险因素，而这种类型在50岁以上[已修正]开始出现症状且在其他部位可见动脉粥样硬化血管壁疾病体征的男性中尤为常见。总之，对于大多数出现雷诺现象的患者，完整的病史和体格检查足以做出正确诊断。补充抗核抗体测定、毛细血管灌注测量和手指皮肤收缩压测量可完善诊断分类。
