伟哥治疗雷诺现象

    近年来，临床研究发现，经扩张血管药物治疗耐药的雷诺现象患者，使用伟哥治疗取得较好的疗效，耐受良好。治疗方法：西地那非50mg，一日2次，连续4周。

Sildenafil in the treatment of Raynaud's phenomenon

resistant to vasodilatory therapy  

BACKGROUND: Vasodilatory therapy of Raynaud's phenomenon represents a difficult clinical problem because treatment often remains inefficient and may be not tolerated because of side effects. METHODS AND RESULTS: To investigate the effects of sildenafil on symptoms and capillary perfusion in patients with Raynaud's phenomenon, we performed a double-blinded, placebo-controlled, fixed-dose, crossover study in 16 patients with symptomatic secondary Raynaud's phenomenon resistant to vasodilatory therapy. Patients were treated with 50 mg sildenafil or placebo twice daily for 4 weeks. Symptoms were assessed by diary cards including a 10-point Raynaud's Condition Score. Capillary flow velocity was measured in digital nailfold capillaries by means of a laser Doppler anemometer. While taking sildenafil, the mean frequency of Raynaud attacks was significantly lower (35+/-14 versus 52+/-18, P=0.0064), the cumulative attack duration was significantly shorter (581+/-133 versus 1046+/-245 minutes, P=0.0038), and the mean Raynaud's Condition Score was significantly lower (2.2+/-0.4 versus 3.0+/-0.5, P=0.0386). Capillary blood flow velocity increased in each individual patient, and the mean capillary flow velocity of all patients more than quadrupled after treatment with sildenafil (0.53+/-0.09 versus 0.13+/-0.02 mm/s, P=0.0004). Two patients reported side effects leading to discontinuation of the study drug. CONCLUSIONS: Sildenafil is an effective and well-tolerated treatment in patients with Raynaud's phenomenon..

解读：

    雷诺现象是一种周围循环疾病。在寒冷或情绪紧张等刺激下，突然发生于指（趾）小动脉的痉挛。典型的雷诺现象症状包括几个或几节手指或脚趾遇冷或情绪紧张后，发作苍白后继青紫，经搓揉或保暖后转为红润，在雷诺现象发作时可伴有局部麻木或刺痛。当遇冷或精神紧张时手指的小肌性动脉、毛细血管前动脉和动静脉吻合网痉挛收缩，血液供应障碍使得手指变得苍白，然后转为青紫，在去除诱因后血管痉挛解除，手指颜色转为正常红色。某些正常人在精神紧张或冷刺激后，手指变白，但由于没有血管结构改变，所以不会发生持久的缺血而变为青紫色。雷诺现象也可继发于某种疾病，如其它结缔组织病、药物或毒物、动脉结构异常、职业因素影响（汽车司机的手——臂振动综合征）和血液系统疾病等。

    雷诺现象常采用扩血管药物如妥拉苏林、利血平、硝苯吡啶、甲基多巴、前列腺素E1和康力龙(stanozol)等药物治疗，预防应保暖、干燥、戒烟，并避免精神激动。

    伟哥（西地那非）治疗雷诺现象的作用机制：西地那非是一种5′- 磷酸二酯酶(PDE5)的选择性抑制剂，降低cGMP降解程度水平，从而扩张血管，发挥治疗作用。