Lau C S, Khan F, Brown R, McCallum P, Belch J J
University Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland.
Angiology. 1995 Jan;46(1):1-10. doi: 10.1177/000331979504600101.
Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful history, the assessment of RP severity is difficult, for the vasopastic attacks are not easily induced under experimental conditions. In this study, the laser Doppler flowmetry (LDF) technique was used to quantify digital blood flow, which was standardized by body cooling and warming in patients with RP. Twenty-one healthy subjects and 56 RP patients were studied: 7 had primary RP, 22 had suspected secondary Raynaud's syndrome (susp RS), and 27 had systemic sclerosis (SSc)-associated secondary Raynaud's syndrome (SSc RS). The inherent variability in the acral cutaneous circulation was minimized by whole-body warming and cooling. Digital blood flow values at environmental temperatures of 40 degrees C, 12 degrees C, and after rewarming, to 40 degrees C were recorded, as was the time taken for blood flow to reach 25%, 50%, and 75% of the full effects of whole-body cooling and rewarming. Patients with primary RP and susp RS had normal blood flow values at ambient temperatures of 40 degrees C, 12 degrees C, and after rewarming to 40 degrees C when compared with controls, but they had significantly faster vasoconstrictor responses to whole-body cooling, suggesting a heightened sympathetic activity. Additionally, they had slower vasodilator responses with longer 25%max response time to whole-body rewarming. Patients with SSc RS had significantly lower blood flow values at 40 degrees C after initial warming and following subsequent rewarming, and despite a normal vasoconstrictor response to cooling, it took longer for them to vasodilate during rewarming, suggesting that poor digital blood flow in these patients may be more related to digital vasculature abnormalities and not an increase in sympathetic activity. In conclusion, our assessment technique can be used to quantify digital blood flow in patients with RP and may be potentially useful in the investigation of the etiologic role of the sympathetic nervous system in RP.
尽管雷诺现象（RP）通常可通过详细的病史轻松做出诊断，但评估RP的严重程度却很困难，因为血管痉挛发作在实验条件下不易诱发。在本研究中，激光多普勒血流仪（LDF）技术被用于量化指端血流量，该血流量在RP患者中通过身体冷却和复温进行标准化。对21名健康受试者和56名RP患者进行了研究：7例为原发性RP，22例为疑似继发性雷诺综合征（susp RS），27例为系统性硬化症（SSc）相关的继发性雷诺综合征（SSc RS）。通过全身加热和冷却将手足皮肤循环的固有变异性降至最低。记录环境温度为40摄氏度、12摄氏度时以及复温至40摄氏度后的指端血流量值，以及血流量达到全身冷却和复温全部效果的25%、50%和75%所需的时间。与对照组相比，原发性RP和susp RS患者在环境温度为40摄氏度、12摄氏度以及复温至40摄氏度时的血流量值正常，但他们对全身冷却的血管收缩反应明显更快，表明交感神经活动增强。此外，他们对全身复温的血管舒张反应较慢，达到最大反应的25%所需时间更长。SSc RS患者在初始加热后和随后复温后40摄氏度时的血流量值显著更低，尽管他们对冷却的血管收缩反应正常，但在复温过程中血管舒张所需时间更长，这表明这些患者指端血流量不佳可能更多与指端血管异常有关，而非交感神经活动增加。总之，我们的评估技术可用于量化RP患者的指端血流量，可能对研究交感神经系统在RP中的病因学作用具有潜在用途。
