There is no consensus on the cause. Renault believes that it is caused by excessive sympathetic nerve activity. Lewis believes that the pathological changes of arterial wall lead to the overreaction of peripheral blood vessels to cold, emotional stress and other stimuli, which is caused by contraction first and then siltation. At present, it is considered that the abnormal function of vascular endothelial cells is the pathophysiological basis of the disease.
3 disease mechanism
Mechanism of Raynaud's phenomenon in limbs
The mechanism of Reynolds phenomenon is not clear. According to various theories, there are the following factors.
Raynaud's phenomenon
① Vasculitis: Under the action of various factors, some antigens combine with phospholipids on vascular endothelial cells, and under the action of complement, vascular endothelial cells are damaged to form vasculitis, resulting in thickening of vascular wall or narrowing of lumen. Under the action of sympathetic nerve, blood vessels are prone to spasm and occlusion.
② Immune dysfunction: Raynaud's phenomenon is more common in connective tissue diseases, such as systemic lupus erythematosus and polymyositis. Among these patients, patients with abnormal humoral and cellular immune indexes are more like RNP and Sm antibodies in blood than patients without Raynaud's syndrome. The immune complex and cold agglutinin in gamma globulin circulation were higher than those without Raynaud's syndrome.
③ Enhanced platelet aggregation: Thromboxane A2(TxA2) produced by platelet activation is a powerful vasoconstrictor and platelet aggregation agent. Arachidonic acid produced by vascular endothelial cells and prostacyclin (PGI2) are vasodilators and agglutination inhibitors. The content of TxA2/PGI2 in plasma of patients with Raynaud's phenomenon is higher than that of patients without Raynaud's phenomenon. At the same time, treatment with thromboxane synthesis inhibitor can alleviate the condition, but the ratio of TxA2/PGI2 is normal, which is presumed to be a kind of compensation for the human body. Since TxA2 and PGI2 are extremely unstable, the metabolites TXB2 and 6- keto -PGFI2 of TxA2 and PGI2 can also be determined. The enhancement of platelet aggregation can increase platelet aggregation in circulation, thus affecting the pathological process of limb blood perfusion and accelerating terminal arterial ischemia.
Mechanism and test of visceral Reynolds phenomenon
(1) lung
Raynaud's phenomenon
Mechanism of Raynaud's phenomenon Patients with primary Raynaud's phenomenon are not limited to peripheral vasospasm, but also accompanied by pulmonary vasospasm. Pulmonary capillary spasm leads to the decrease of the number of capillary beds and the decrease of pulmonary diffusion function. Although the pulmonary diffusion of carbon monoxide (DLCO) has not changed in patients with secondary Raynaud's syndrome, the nail fold microcirculation has also changed abnormally after cold stimulation. It is suggested that patients with secondary Raynaud's phenomenon have pulmonary interstitial or vascular bed damage, and pulmonary fibrosis or pulmonary hypertension limit the reactivity of pulmonary circulation.
(2) Mechanism of cardiac Raynaud phenomenon
Using 20 1TI (thallium) myocardial imaging to measure the myocardial injury of Raynaud's syndrome patients before and after cold stimulation is a noninvasive myocardial ischemia examination, and the amount of thallium absorbed by muscle is directly proportional to the regional myocardial blood flow and cell function. Some people used this method to examine patients with progressive systemic sclerosis with myocardial damage, and found that 13 cases induced Raynaud phenomenon after cold stimulation, and myocardial blood perfusion decreased. Domestic research by Li Ming and others also found that 5 out of 6 cases had this phenomenon, but this myocardial ischemia was transient. When the Reynolds phenomenon at the end of the limb is relieved, the vasospasm of the heart can also be relieved. Bulkley et al analyzed the autopsy data of 52 patients with progressive systemic sclerosis. Among them, about 23 patients developed focal contraction band necrosis and secondary myocardial fibrosis, but the internal organs of coronary artery outside the ventricular wall of these patients were smooth and unobstructed. Contractile banded necrosis is a special pathological change after myocardial cell injury, which is different from coagulative necrosis caused by persistent coronary infarction. It is caused by blood reperfusion after myocardial ischemia, that is, cardiac Raynaud phenomenon, and this myocardial injury is cumulative.
(3) Mechanism of brain Raynaud phenomenon
It has been found abroad that patients with recurrent stroke have no other stroke history except wandering headache and Raynaud phenomenon, and their cerebral arterial rheogram and EEG are normal. It is speculated that recurrent stroke is related to brain Raynaud's syndrome. At home, Li Ming et al. used 99mTc-HM-PAO cerebral blood perfusion tomography to check the cerebral blood perfusion of connective tissue disease patients after cold stimulation and at rest. In Raynaud's syndrome's group, when cold stimulation induced Raynaud's syndrome in limbs, 8 patients showed multiple or even systemic focal blood perfusion reduction areas. In the resting state without Reynolds phenomenon, most of these reduced areas returned to the control group to varying degrees, and there was no Reynolds phenomenon.
Raynaud's phenomenon
There is no such phenomenon in patients with systemic lupus erythematosus. This temporary decrease in cerebral blood flow perfusion associated with Raynaud's syndrome in limbs may be due to Raynaud's syndrome in the brain. It has also been reported that the incidence of Raynaud phenomenon in migraine patients is higher than that in the control group.
(D) Mechanism of renal Raynaud phenomenon
Some people use 133Xe renal perfusion imaging to measure renal cortical blood flow. When Raynaud's phenomenon was induced by cold stimulation in 4 patients with progressive systemic sclerosis, the renal cortical blood flow decreased by an average of 32% compared with that before Raynaud's phenomenon, while in 4 normal subjects it decreased by only 65,438 00%. After renal artery injection of aminophylline, the cortical blood flow of 3 patients increased rapidly, suggesting that the decrease of blood flow was caused by renal vasospasm.
4 disease symptoms
The typical attack of Reynolds phenomenon can be divided into three stages:
1. Early pallor
Raynaud's phenomenon
Due to the spasm of arterioles at the end of limbs, the blood flow of skin vessels suddenly decreases, which generally occurs in fingers and develops symmetrically from fingertips to palms, rarely exceeding wrists. The local skin temperature of the hand is reduced, with numbness, acupuncture and stiffness.
2. Blue after a few minutes
The arterioles dilate first, while the venules are still in a state of spasm, and the capillary plexus is anoxic and blue. At this time, the symptoms are generally mild.
flush
When the patient is in a warm environment, the cold stimulation disappears, the blood vessels are congested, the local temperature rises, and swelling and mild pulsatile pain may occur. When hemoperfusion is normal, skin color and conscious symptoms return to normal. The onset of Raynaud's phenomenon can also affect the tip of the nose, cheeks and auricles for several minutes to several hours. The frequent occurrence of Raynaud's phenomenon causes malnutrition in the skin and nails of the last toe, and in severe cases, ulcers and gangrene appear at the fingertips, or fingers become shorter.
5 disease diagnosis
Medical/medical records
Raynaud's phenomenon
The diagnosis of Raynaud's syndrome in limbs is not difficult. By asking, the patient can describe the symptoms of a typical attack in detail. Some people think that the existence of Reynolds phenomenon alone for more than two years is an important condition for diagnosing primary Reynolds phenomenon. However, in recent years, clinical studies have shown that Raynaud's phenomenon has existed alone for more than 10 years, and some patients have developed connective tissue disease, with the onset age of 20-30 years, and some patients have family history. The incidence ratio of female to male is about 10: 1. Those with a long course of disease should be differentiated from acrocyanosis, and the course of disease is as long as 24 years.
physical examination
(1) cold water stimulation test
Let the patient sit quietly in a warm room for 20-30 minutes, and then immerse his hands or feet in ice water at 4℃. After about 1-2 minutes, the local skin color can be observed as pale. After leaving the water for 2-5 minutes, the skin turns purple and red, accompanied by local chills and tingling, and the attack stops after a few minutes. This method can estimate the degree of disease and the therapeutic effect, and is widely used in China.
(2) Nail fold capillary examination
It can be seen that the patient's capillaries have abnormal congestion, dark red color, slow blood flow and abnormal flow pattern. However, normal people do not have this phenomenon. This method is very common in China.
(3) Laser Doppler blood flow meter
Laser is emitted into the skin (skin) through optical fiber.
Laser Doppler flowmetry
Subsurface 1mm) When human photons meet red blood cells moving in microcirculation, their frequency changes, and the emitted light is collected through the skin, converted into signals and displayed, and the flow rate and flow rate of blood are calculated. now
Raynaud's phenomenon
At present, there is no report on this detection method.
(4) Radionuclide determination
Radionuclide 13 1I sodium can be used to determine the nutritional blood flow of the affected finger.
(5) Microcirculation microscope
In foreign countries, intradermal capillaries can be displayed on TV screens to directly record the velocity and flow rate, or inserted into the capillary network to measure the pressure change.
(6) Volume and Photoplethysmograph
The increase and decrease of finger ring surface and the pulse of finger artery were measured to estimate the change of blood flow. The blood flow of the affected finger decreases and the pulse amplitude of the artery decreases.
(7) Arteriography of upper limbs
After the first angiography, immerse your hand in ice water for 20 seconds, dry it, and then do another angiography. In addition to digital artery spasm, it can also involve the larger palmar artery and even the forearm artery.
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(a) cold agglutinin antibody in the serum of some patients can be found in cold agglutinin. 15-20℃, the antibody binds to glycoprotein I/i antigen on erythrocyte membrane to agglutinate it, and then lyses red blood cells. At 37℃, most of them can be dissociated into IgM. The titer of condensate in normal serum is below 1: 32, and the cold agglutinin titer of Raynaud's disease can reach 1: 65432. Such as viral pneumonia, infectious mononucleosis, rubella, lymphoma and systemic lupus erythematosus.
(2) cryoglobulinemia
Plasma can be precipitated at 4℃ and dissolved above 37℃. The plasma fibrinogen of normal people is 2-4 g/L, but it can exceed this value in Raynaud's disease. This symptom is also seen in patients with measles paroxysmal cold hemoglobinuria, such as acrocyanosis, reticular cyanosis and cold. Massive cryoglobulinemia is only found in multiple myeloma.
(3) Other antibodies
Due to immune dysfunction, the serum RNP antibody, anti-Sm antibody (an RNA-linked nucleoprotein polypeptide antibody), γ-globulin and IgG in patients with Raynaud's syndrome are higher than those without Raynaud's syndrome.
6 Differential diagnosis
First, systemic lupus erythematosus.
Also known as systemic lupus erythematosus, 80% patients can have skin lesions, especially butterfly erythema on the face. Skin lesions can be the earliest or even the only clinical symptom, which is more common in young and middle-aged women. Erythema usually appears before systemic symptoms, but also at the same time or later. At different stages of the disease, the color ranges from reddish, bright red to purplish red. When the inflammation subsides, scales or pigmentation may appear, and sometimes telangiectasia or slight skin atrophy may occur. Palm, sole, palm, toes and toes are bent. 90% of patients may be accompanied by fever, which varies from low fever to 40℃. 90% patients may be accompanied by joint pain, 18%-45% patients may have Raynaud phenomenon, which is a typical three-phase reaction after a cold. Lupus cells can be found in 50%-80% patients, especially in the acute stage. However, lupus cells can also be found in 17% patients with rheumatoid arthritis, dermatomyositis and systemic scleroderma, which should be differentiated. Kidney damage is the most common organ damage, with an incidence of 50%-70%. High titer anti-ds-DNA antibody is the marker antibody of systemic lupus erythematosus, followed by anti-ss-DNA antibody (70%), anti-histone antibody (70%), anti-Sm antibody (30%-40%), anti-RNP antibody (30%-50%), anti-Ma antibody (20%) and anti-La/SSB antibody (70%).
Second, progressive systemic sclerosis (PSS)
Raynaud's phenomenon
This disease is characterized by extensive or systemic skin sclerosis, involving multiple systems, and eventually leading to skin atrophy. The onset of this disease is slow, the earliest symptom is often Raynaud phenomenon, the incidence rate is as high as 80%-90%, and it is more prone to attack after a cold, with typical three-stage skin changes. Therefore, Raynaud phenomenon has important diagnostic significance for progressive systemic sclerosis. At first, the hands, feet and skin appeared non-concave and hard swelling, and the surface was smooth. Abnormal wrinkles are pale yellow or pale, and gradually spread to the neck, shoulders, limbs and trunk. You can also start from the trunk or limbs. In the process of swelling development, the skin gradually hardens. Because the facial skin is tight, it is difficult to open the mouth, and the expressionless tongue band is shortened, which makes the tongue movement disorder. Because of sclerosis, it is difficult for fingers to move in a semi-curved shape, and ulcers and atrophy may form. Progressive systemic sclerosis can have multiple system lesions. The incidence of bone, joint and muscle diseases is 50%- 100%. The digestive tract can involve the rectum from the mouth, and diarrhea and constipation often appear alternately when the small intestine is involved. Pulmonary fibrosis can lead to dyspnea and tightness in the chest. Renal involvement can lead to hypertension and acute renal failure, and myocardial fibrosis can lead to poor prognosis in patients with severe cardiac insufficiency. Laboratory examination: There are more women than men (about 3-4: 1) who may have accelerated erythrocyte sedimentation rate and increased gamma globulin, and most of them are adults, so we should pay attention to distinguish them from adult scleredema and acrosclerosis dermatomyositis.
Third, arteriosclerosis.
It is characterized by only skin sclerosis.
Acrosclerosis
At the extremities, the face and neck may also be involved. Intermittent mink phenomenon appeared in hands and feet before skin sclerosis, which had typical three-phase manifestations. After a long-term attack, sclerosis spreads upward from the tip of the finger (toe) to the finger (or instep), even to the forearm or calf, which can cause finger (toe) ulcer, finger (toe) nail malnutrition, atrophy or shedding, and generally does not affect the internal organs of the whole body, with a good prognosis. However, some studies show that individual patients with acrosclerosis can eventually develop progressive systemic sclerosis.
Fourth, polymyositis or dermatomyositis.
This is an autoimmune disease with rhabdomyodegeneration and necrotizing inflammation as the main pathological changes, which can be divided into acute, subacute and chronic diseases. The common chronic process is that there is no difference between men and women, and adults and children can get sick. 60% of patients with skin lesions can have edema, erythema, pigmentation and telangiectasia. The lesions with diagnostic value are called "purplish red eyelids", that is, the purplish red lesions with edema on the upper eyelid are unique to dermatomyositis. The papules protruding from elbow, knee or ankle on the extension side of knuckle have high diagnostic value. 10%-20% patients have Raynaud's phenomenon, and the muscle symptom is swelling. Tenderness and limited joint movement can make you feel tired in your legs when you go upstairs, and feel back pain when you comb your hair and lift your arms. Muscle symptoms can occur at the same time as skin lesions, or earlier or later. Different patients have different degrees of rash and muscle degeneration. Systemic symptoms include sweating, fever and anemia. Laboratory examination: CPRALT, AST and LDH increased, and 24 h urine creatine >; 200 rug muscle biopsy is of great significance, showing degeneration or rupture of muscle fibers, and 20% of adult patients are complicated with malignant tumors.
Five, mixed connective tissue disease (MCTD)
It also has the symptoms of progressive systemic sclerosis lupus erythematosus and polymyositis or dermatomyositis, such as facial erythema and telangiectasia in systemic lupus erythematosus; There are purple spots of dermatomyositis, atrophic erythema of swollen joint extension surface, skin sclerosis and pigmentation of skin sclerosis. 95% patients have high titer of anti-ribonucleoprotein antibody in their blood (anti-RNP human fluorescent antibody test shows that high titer of speckle Raynaud phenomenon is a valuable early symptom of this disease. Recurrent Raynaud's phenomenon can lead to finger (toe) ulcer. This disease has a good effect on adrenocortical hormone.
Six, rheumatoid arthritis
This is a chronic symmetrical, polyarthritis-based systemic disease. Unknown etiology is generally considered to be an autoimmune reaction caused by infection. Typical skin symptoms are rheumatoid nodules, which occur in 20%-30% of patients, mainly in the elbow. Nodules are spherical, hard and without obvious tenderness. Rheumatoid arthritis can cause various vascular injuries, including arteritis, capillary inflammation and phlebitis. It has been reported that the incidence rate in Raynaud's syndrome is 18.9%, and there are more patients with pyoderma gangrenosum, with erythema on the palm of the hand. 25%-30% of juvenile rheumatoid arthritis has a characteristic rash, mostly located in trunk and limbs, and most of the joints involved are hands, wrists, knees and feet. The joint is swollen, tender and stiff, and the joint stiffness is most obvious when getting up in the morning, which is called relief after morning stiffness activity. Can involve the heart; About 40%-50% of patients with B disease have pericarditis, and pleural effusion is the most common.
Seven, Sjogren's syndrome (SS)
This is an autoimmune disease.
sicca syndrome
The obvious symptom of the disease is that my membrane is dry, mainly invading lacrimal gland and salivary gland. The atrophy of lacrimal gland leads to the decrease of lacrimal gland secretion. Salivary glands atrophy and dry mouth occurs, including dry mouth, dry lips, thirst and dry mouth. The tongue membrane is dry and red. 50% patients with rheumatoid arthritis, some patients with polymyositis, systemic lupus erythematosus and scleroderma, parotid gland and thyroid gland may be swollen, and some patients with hepatosplenomegaly may have non-thrombocytopenic epilepsy. Fingers and lips often have telangiectasia. 25% patients have Raynaud's syndrome, and their hair tends to be dry and fragile. Most patients with pubic hair and axillary hair are women. Laboratory examination: the titer of rheumatoid factor and antinuclear antibody are both >: 1: 160. Leukopenia and eosinophilia are often accompanied by hypergammaglobulinemia, and a few patients may have concentrated globulin and lupus cells.
Eight, arteriosclerosis obliterans
A disease of chronic stenosis or occlusion of peripheral arteries caused by atherosclerotic lesions, which is mainly seen in symptoms such as cold sensation, numbness and intermittent rupture pain caused by ischemia of large and medium-sized arteries in lower limbs. In the later stage, due to malnutrition of the affected limbs, ulcers and gangrene of toes, feet and legs may occur. Most of the patients are men, and their age is over 50. Among them, 20% have diabetes and 35% have hypertension.
Nine, thromboangiitis obliterans
Chronic inflammation and occlusion of arteries and veins cause severe pain, and local tissues often gangrene due to ischemia, which can lead to "intermittent rupture" in 75% patients with limb end injury. More seriously, due to ischemia of local tissues and nerve endings, severe paroxysmal pain will occur in lower limbs and toes at rest. There is a beating burning sensation at the ulcer and gangrene, and the heaviest pulse of the dorsal artery of the foot can disappear at night. Smoking is an important inducement among men aged 25-50. Differentiation of three peripheral vascular diseases.
Polyarteritis nodosa
This is a systemic disease, skin lesions.
polyarteritis nodosa
Spots are subcutaneous nodules and erythema nodules distributed along blood vessels, which can lead to necrosis and ulcer and form epileptic marks. The incidence of male and female is 7: 4. The patient developed skin lesions, fever, peripheral neuritis, muscle joint pain, loss of appetite and weight loss 1/3- 1/4. Common are single or clustered subcutaneous nodules along the blood vessels of the calf, and tender nodules with or without adhesion to the epidermis, such as soybeans to red dates. The skin surface can be bright red or dark red with normal skin color. Sometimes edema occurs, and soon the nodules can be necrotic, forming an ulcer that is difficult to heal. After several months or more, the ulcer healed, leaving obvious traces of epilepsy and pigmentation. Erythema, wheezing, reticular ecchymosis and acromegaly can be seen on the skin, and Raynaud phenomenon can occur.
Xi。 cryoglobulinemia
It is characterized by local cyanosis, purple horn, Raynaud's reticular macula or cold measles in exposed parts such as hands, feet, auricles and nasal tip after cold stimulation. There is even skin necrosis or ulcer. Conscious symptoms are numbness and tingling, which are more common in young people or children.
This disease can be divided into primary and secondary types, which can be seen in lupus erythematosus, polyarteritis nodosa, Sjogren's syndrome of systemic sclerosis, allergic vasculitis, reticular macula of extremities, xanthoma, cicatricial dermatitis and Ling Ye's disease. There are also some malignant tumors, such as multiple myeloma, lymphosarcoma, liver cancer, chronic lymphocytic leukemia, and chronic infections, such as syphilis, leishmaniasis, and neoplastic leprosy. And the unknown cause is called cryoglobulin >: 250mg/L, which can be confirmed by the following methods: taking venous blood 10mm, separating serum at 37℃ and putting it in a refrigerator at 4℃, precipitation and gelatinization will occur, and putting it back at 37℃ for dissolution. Put the ice water test tube on the patient's skin, lh will appear purple paralysis, put the ice water test tube on the eyelid, and you can see with a living microscope that the red blood cells in the eyelid blood vessels are like paper money or arranged in strings, and the blood flow is slow. Laboratory examination: The serum reaction of rheumatoid factor and antinuclear antibody syphilis may be positive, with red blood cells and protein in urine, cryoglobulin in cerebrospinal fluid and abnormal renal function.
Twelve, cold agglutinin disease
When the cold agglutinin in the body increases, under cold stimulation, it can cause skin Raynaud's syndrome, typical three-phase reaction, limb necrosis and ulcer, and the titer of cold agglutinin in serum increases.
Thirteen, thoracic outlet syndrome
In the narrow part of clavicle and rib 1.
thoracic-outlet-syndrome
Abnormal cervical rib 1 rib of anterior scalene muscle can compress brachial plexus and subclavian artery, resulting in nerve injury and vascular dysfunction. The disorder of the superior ulnar nerve is caused by the compression of the lower brachial plexus. At the same time, the subclavian artery is compressed, and the symptoms of insufficient blood supply to the upper limbs appear, that is, Raynaud phenomenon. This abnormal situation can be seen in the cervical rib (the rib protruding from the cervical vertebra is called cervical assist), which is a congenital abnormal palpable mass of the neck and supraclavicular fossa. Usually seen in X-ray examination), anterior scalene syndrome (when spasm occurs due to inflammation, such as when the patient's head rotates to the opposite side, the pain can be aggravated and the torsional artery pulse disappears), and it can also be seen in subclavian artery aneurysm and costal-clavicular syndrome.
XIV. Flooding
In fact, it is a kind of frostbite, which will happen to crew members who have been immersed in seawater for a long time. At first, the feet were pale and unconscious. After leaving the water, the feet become red and hot, and ecchymosis and water cancer appear. At the same time, it was accompanied by severe pain and vasospasm in Raynaud's syndrome after paresthesia.
7 disease treatment editor
General preventive measures include: keeping warm to prevent frostbite and skin damage; Drink a small amount of wine to increase blood circulation, do not smoke, and avoid mental stress and overwork. Severe patients in Raynaud's syndrome take vasodilators orally, and their fingers can be coated with nitroglycerin ointment or lidocaine. If Raynaud's phenomenon persists, it is recommended to go to Rheumatology Department for corresponding examination and long-term follow-up.
Prescription: eat more warm soup.
1. Jujube and ginger soup
The main raw material is jujube,
Jujube ginger soup
Ginger, brown sugar, the specific method is 10 jujube, 5 slices of ginger, appropriate amount of brown sugar, decoction instead of tea, once a day 1 time, insist on taking. Drinking jujube ginger soup often can improve the symptoms of cold hands and feet. Jujube is sweet, which has the functions of tonifying the middle energizer, nourishing blood and calming the nerves, while ginger is pungent, which has the functions of stopping vomiting, relieving exterior syndrome and dispelling cold. The combination of the two can give full play to the significance of warming ginger and nourishing jujube, promote blood circulation, improve blood circulation of the whole body accordingly, and naturally warm hands and feet.
Brown sugar in soup also has the functions of tonifying the middle energizer, nourishing blood and promoting blood circulation. Modern pharmacological studies have confirmed that gingerol contained in ginger has a direct exciting effect on the heart and vascular movement center, which can accelerate the heartbeat, dilate blood vessels and smooth collaterals, thus improving body surface circulation and making people feel feverish all over.
2. Fried mutton with shredded ginger
Slice the mutton. Shred ginger. Add a little oil to the pot and the fire will start. When the oil smokes, add pepper and star anise, stir-fry until fragrant, add shredded ginger, stir-fry, add mutton slices, add salt and monosodium glutamate, and pour sesame oil out of the pot.
8 disease prevention editor
Including avoiding cold stimulation and emotional excitement, prohibiting smoking, avoiding the use of ergotamine beta blockers and contraceptives, and those caused by obvious occupational reasons (long-term use of vibrating tools at low temperature), try to change to type I, and be careful to protect your fingers from trauma. Minor injuries can easily lead to fingertip ulcers or other nutritional diseases. Drinking a small amount of alcoholic beverages in daily life can improve symptoms. If conditions permit, people can move to a mild and dry climate, which can reduce the onset of symptoms, alleviate patients' mental anxiety and remain optimistic. All these are important preventive measures.
9 disease prognosis editor
The prognosis is relatively good, about 15% patients are in natural remission and 30% patients are getting worse gradually. Long-term persistent arterial spasm can lead to irreversible arterial stenosis, but rarely (less than 1%) need to amputate fingers. [ 1]
10 Special tips for editing
The foot is the farthest place from the heart, and the blood supply is poor. In addition, there is less subcutaneous fat and poor warmth retention. Therefore, special "care" should be given to the feet. Usually, we should insist on soaking our feet with hot water to promote blood circulation. In addition, because high blood pressure and arteriosclerosis are the causes of cold hands and feet, it is necessary to avoid overwork, excessive drinking and smoking, and not to eat salty food.