雷诺现象(RP)是一种以偶发性为特征的疾病,手指和脚趾的血管过度收缩,由寒冷或压力引发。这导致数字中颜色变化的独特序列。苍白表明由于缺氧导致血流量减少,而红斑则表现为再灌注。RP可以是主要的,没有可识别的根本原因,或次要的,与其他条件有关。这些疾病包括自身免疫性疾病,最常见的是系统性硬化症,血管疾病;和神经系统疾病。虽然RP的确切原因尚不清楚,遗传和激素(雌激素)因素可能是贡献者。RP的发病机制涉及血管壁之间复杂的相互作用,神经,荷尔蒙,和体液因素,破坏血管收缩和血管舒张之间的平衡。在主RP中,血管异常主要是功能性的。然而,在二级RP中,功能和结构成分都存在于血管中。这解释了为什么数字组织损伤经常发生在继发性RP而不是原发性RP中。RP的诊断主要是临床诊断。成像技术的最新进展有助于诊断和监测,但甲皱毛细管镜检查仍然是区分原发性和继发性RP的金标准。如果有急性缺血性损伤的迹象,血管成像,特别是术前,对于排除其他血管闭塞状况至关重要。RP的管理侧重于减轻症状和预防组织损伤。当温暖和压力管理等一般措施不足时,血管扩张剂药物是一线治疗。二氢吡啶类钙通道阻滞剂(CCB),比如硝苯地平,通常用于血管舒张。磷酸二酯酶-5抑制剂和前列腺素类似物是对CCB无反应或有缺血性组织损伤的患者的替代选择。波生坦,内皮素-1受体拮抗剂,已经显示出治疗和预防数字溃疡的有效性,尤其是多发性溃疡患者。对于严重的病例,肉毒杆菌毒素注射或交感神经切除术可用于控制RP症状。然而,肉毒杆菌毒素注射需要反复给药,和交感神经切除术的长期有效性是不确定的。脂肪移植是促进愈合和防止组织损伤的一种有前途的手术疗法。
Raynaud\'s phenomenon (RP) is a condition characterized by episodic, excessive vasoconstriction in the fingers and toes, triggered by cold or stress. This leads to a distinctive sequence of color changes in the digits. Pallor indicates reduced blood flow due to oxygen deprivation, while erythema appears as reperfusion. RP can be primary, with no identifiable underlying cause, or secondary, associated with other conditions. These conditions include autoimmune diseases, most commonly systemic sclerosis, vascular diseases; and neurological conditions. While the exact cause of RP remains unclear, genetic and hormonal (estrogen) factors are likely contributors. The pathogenesis of RP involves a complex interaction between the vascular wall, nerves, hormones, and humoral factors, disrupting the balance between vasoconstriction and vasodilation. In primary RP, the vascular abnormalities are primarily functional. However, in secondary RP, both functional and structural components occur in blood vessels. This explains why digital tissue damage frequently occurs in secondary RP but not primary RP. Diagnosis of RP is primarily clinical. Recent advancements in imaging techniques have aided in diagnosis and monitoring, but nail fold capillaroscopy remains the gold standard for distinguishing between primary and secondary RP. If there are signs of acute ischemic injury, vascular imaging, particularly preoperatively, is crucial to rule out other vaso-occlusive conditions. Management of RP focuses on alleviating symptoms and preventing tissue damage. Vasodilator medications are the first-line treatment when general measures like warmth and stress management are not sufficient. Dihydropyridine calcium channel blockers (CCBs), such as nifedipine, are commonly used for vasodilation. Phosphodiesterase-5 inhibitors and prostaglandin analogs are alternative options for patients who do not respond to CCBs or have ischemic tissue damage. Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers. For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control RP symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy\'s long-term effectiveness is uncertain. Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.