Vayssairat M, Evenou P, Baudot N, Priollet P, Gilard M
Service d'Angiologie, Hôpital Broussais, Paris, France.
Ann Vasc Surg. 1987 May;1(4):474-8. doi: 10.1016/S0890-5096(06)60735-8.
An objective test for the diagnosis of Raynaud's phenomenon is useful for three reasons: 1. the phenomenon may not be evident at the time of the clinical examination, 2. proof of diagnosis is required by insurance companies when an occupational origin is suspected, and 3. to assess drug induced improvement. Most cold tests in the medical literature are either complex and expensive or unreliable for routine clinical use. We studied cold induced post-ischemic reactive hyperemia in 14 patients with Raynaud's disease and in 15 healthy controls. The hand was immersed in a stirred water bath at 13 degrees C, and ischemia was induced by placing an inflatable tourniquet around a finger for five minutes. Afterwards the tourniquet was deflated while the hand remained in the cold water bath. The temperature of the finger with the deflated tourniquet was compared with that of an adjacent finger serving as control. Hyperemia was the increase in differential temperature between these two fingers after tourniquet release minus the difference in temperature existing before deflating the tourniquet. With a normal lower limit of 0.7 degrees C for hyperemia, 13 of the 14 patients with Raynaud's phenomenon were abnormal (93% sensitivity), and 14 of the 15 controls were normal (93% specificity). All these 14 controls were also normal at a second examination done to assess test reproducibility. A false-positive healthy control was still positive at the second examination. This new, simple and inexpensive cold test can reliably diagnose Raynaud's phenomenon. Further studies are necessary to establish its reliability in monitoring the effectiveness of treatment in prospective trials.
用于诊断雷诺现象的客观测试之所以有用，有三个原因：1. 该现象在临床检查时可能不明显；2. 当怀疑职业性病因时，保险公司需要诊断证明；3. 用于评估药物诱导的改善情况。医学文献中的大多数冷试验要么复杂昂贵，要么对于常规临床应用不可靠。我们研究了14例雷诺病患者和15名健康对照者的冷诱导缺血后反应性充血情况。将手浸入13摄氏度的搅拌水浴中，通过在手指周围放置充气止血带五分钟来诱导缺血。之后，在手部仍留在冷水浴中的同时松开止血带。将松开止血带的手指温度与相邻作为对照的手指温度进行比较。充血是指止血带松开后这两个手指之间的温差增加量减去松开止血带前存在的温差。充血的正常下限为0.7摄氏度，14例雷诺现象患者中有13例异常（敏感性为93%），15名对照者中有14名正常（特异性为93%）。在为评估测试可重复性而进行的第二次检查中，所有这15名对照者也都正常。一名假阳性的健康对照者在第二次检查时仍然呈阳性。这种新的、简单且廉价的冷试验能够可靠地诊断雷诺现象。有必要进行进一步研究以确定其在前瞻性试验中监测治疗效果的可靠性。
