Maricq H R, Weinrich M C, Valter I, Palesch Y Y, Maricq J G
Department of Medicine, Medical University of South Carolina, Charleston, Charleston 29425, USA.
J Rheumatol. 1996 Dec;23(12):2068-78.
To define differences in digital vascular responses to cooling and to determine their usefulness for the differential diagnosis of 4 groups of subjects: patients with primary Raynaud's phenomenon (RP) (n = 96), patients with RP associated with scleroderma (systemic sclerosis, SSc) spectrum disorders (SSc spectrum RP) (n = 108), subjects complaining of cold sensitivity of the fingers (n = 88), and RP negative controls (n = 120).
Digital systolic blood pressure, digital blood flow, and digital skin temperature were measured in a temperature controlled room at 18 or 23 degrees C; the effect of local finger cooling was tested at 30, 20, 15, and 10 degrees C.
Digital blood pressure responses clearly differentiate the 4 diagnostic groups from each other. By contrast, blood flow and skin temperature measurements, although showing different group means, fail to reach statistical significance due to a large variance. Digital pressure responses have high sensitivity and specificity for distinguishing not only between patients with RP and controls, but also between the 2 types of RP. A relative digital systolic pressure (digital systolic pressure over brachial systolic pressure) of less than 70% at low local finger cooling temperatures (15 and 10 degrees C) has a sensitivity of 97.1% in differentiating SSc spectrum RP from primary RP. A zero reopening pressure shows a specificity of 100% at 30 degrees C and 81.7% at 20 degrees C to separate the 2 groups. The zero reopening pressure is seldom associated with clinically visible RP (10.3% among SSc spectrum RP, 4.3% among primary RP). Although the study was not designed to investigate drug effects, our data from patients who failed to abstain from vasodilators, as instructed, show they have a protective effect at 15 and 10 degrees C.
The digital pressure response to cooling is a useful test for RP and cold sensitive subjects. It has high sensitivity and specificity to differentiate between SSc spectrum RP and primary RP and between primary RP and cold sensitive subjects. Our preliminary data on vasodilator use suggest that the digital pressure response to cooling may also be useful in RP treatment studies.
明确手指血管对冷却的反应差异，并确定其在4组受试者鉴别诊断中的作用：原发性雷诺现象（RP）患者（n = 96）、与硬皮病（系统性硬化症，SSc）谱系障碍相关的RP患者（SSc谱系RP）（n = 108）、主诉手指冷敏感的受试者（n = 88）以及RP阴性对照者（n = 120）。
在温度控制为18或23摄氏度的房间内测量手指收缩压、手指血流量和手指皮肤温度；在30、20、15和10摄氏度测试局部手指冷却的效果。
手指血压反应能清晰区分这4个诊断组。相比之下，血流量和皮肤温度测量结果虽显示出不同组均值，但因方差较大未达到统计学显著性。手指压力反应不仅在区分RP患者与对照者方面，而且在区分两种类型的RP方面都具有高敏感性和特异性。在低局部手指冷却温度（15和10摄氏度）下，相对手指收缩压（手指收缩压与肱动脉收缩压之比）低于70%在区分SSc谱系RP与原发性RP时敏感性为97.1%。零再开放压力在30摄氏度时特异性为100%，在20摄氏度时为81.7%，可区分这两组。零再开放压力很少与临床上可见的RP相关（SSc谱系RP中为10.3%，原发性RP中为4.3%）。尽管该研究并非设计用于调查药物效果，但我们从未按指示停用血管扩张剂的患者获得的数据显示，它们在15和10摄氏度时有保护作用。
手指对冷却压力的反应对RP患者和冷敏感受试者是一项有用的检测。它在区分SSc谱系RP与原发性RP以及原发性RP与冷敏感受试者方面具有高敏感性和特异性。我们关于血管扩张剂使用的初步数据表明，手指对冷却的压力反应在RP治疗研究中可能也有用。
