Wigley F M
Division of Molecular and Clinical Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Curr Opin Rheumatol. 1993 Nov;5(6):773-84. doi: 10.1097/00002281-199305060-00013.
The classification of Raynaud's phenomenon has been complicated by various confusing labels, including Raynaud's disease and Raynaud's syndrome. To improve clarity and to allow for uniformity in reporting, most investigators agree that only the terms primary and secondary Raynaud's phenomenon should be used for patient classification. The prevalence of Raynaud's phenomenon seems to vary among different populations and different climates, suggesting genetic and environmental influences on its expression. The concept that Raynaud's phenomenon is the manifestation of a generalized vasospastic disorder has been addressed by studies of migraine headaches, variant angina, and the pulmonary vascular circulation. Current data suggest that the pathophysiology of Raynaud's phenomenon is complex and multifactorial, involving the endothelium, neuroreceptor expression, and locally produced mediators that affect vascular responses. New and old diagnostic tools used to measure digital circulation continue to be tested in an effort to define a better method of evaluating patients. Occupational causes of Raynaud's phenomenon continue to be an important health problem despite efforts to control vibratory tool usage. The role of beta-blockers in the induction of Raynaud's phenomenon has been questioned, but the use of chemotherapeutic agents is a definite risk factor. A new radical surgical approach for severe refractory Raynaud's phenomenon was described. Intravenous prostaglandins continue to appear helpful in the treatment of severe Raynaud's phenomenon, and oral prostaglandins are beginning to be studied.
雷诺现象的分类因各种令人困惑的术语而变得复杂，包括雷诺病和雷诺综合征。为了提高清晰度并使报告具有一致性，大多数研究者一致认为，在对患者进行分类时应仅使用原发性和继发性雷诺现象这两个术语。雷诺现象的患病率在不同人群和不同气候条件下似乎有所不同，这表明遗传和环境因素对其表现有影响。偏头痛、变异型心绞痛和肺循环的研究探讨了雷诺现象是全身性血管痉挛性疾病表现的这一概念。目前的数据表明，雷诺现象的病理生理学是复杂且多因素的，涉及内皮、神经受体表达以及影响血管反应的局部产生的介质。用于测量手指循环的新旧诊断工具仍在不断接受测试，以努力确定一种更好的评估患者的方法。尽管已努力控制振动工具的使用，但雷诺现象的职业性病因仍是一个重要的健康问题。β受体阻滞剂在诱发雷诺现象中的作用受到质疑，但使用化疗药物肯定是一个危险因素。描述了一种针对严重难治性雷诺现象的新的根治性手术方法。静脉注射前列腺素在治疗严重雷诺现象中似乎仍然有效，口服前列腺素也开始得到研究。
