系统性硬化症合并肺间质病变患者甲襞微循环特征分析

Characteristic analysis of nailfold microcirculation in SSc with ILD patients

目的分析系统性硬化症(SSc)患者合并肺间质病变(ILD)甲襞微循环改变的特征,了解其在诊断SSc合并ILD中的作用及临床意义。方法回顾性分析四川大学华西医院风湿免疫科SSc患者55例,按照是否合并ILD分为SSc合并ILD组(SSc-ILD,n=38)以及SSc未合并ILD组(n=17),记录其一般资料,病程,临床表现,实验室检查指标包括血常规、血沉、生化、免疫、C反应蛋白、血气分析,肺部HRCT表现,肺功能检查,以及甲襞微循环的典型图片及结果等。结果 SSc-ILD组与SSc未合并ILD组在患者的性别、年龄、吸烟史、SSc确诊时间、雷诺现象发生率及持续时间等指标上组间差异均无统计学意义(P>0.05),两组在中高滴度抗核抗体(ANA≥1∶320)、肺功能检查肺活量(VC)、用力肺活量(FVC)、第一秒用力呼气容积与用力肺活量之比(FEV1/FVC)、以及一氧化碳弥散量(DLCO)这五项指标,组间差异有统计学意义(P<0.05)。在甲襞微循环表现上,SSc-ILD组与SSc未合并ILD组相比,SSc-ILD组管袢清晰度较差,管袢模糊比例明显高于未合并ILD组,两组比较差异有统计学意义(P<0.05);SSc-ILD组管袢畸形、管袢短小、管袢纤细、袢周渗出、袢周出血比例均明显高于未合并ILD组,两组比较差异有统计学意义(P<0.05)。结论甲襞微循环在SSc合并ILD患者较SSc未合并ILD患者有明显改变,SSc合并ILD患者不仅从管袢清晰度,乃至管袢形态上均较未合并ILD患者改变明显,提示甲襞微循环可以作为诊断SSc患者肺间质病变的一项辅助指标。

Objective To investigate the role of nailfold microcirculation in systemic sclerosis（SSc） with Interstitial Lung Disease（ILD）. Methods We collected the clinical manifestations, laboratory data image finding, high-resolution computed tomography of lung, pulmonary function data, nailfold mierocirculation manifestations of 55 patients with SSc treated from August 2014 to December 2015 in the in-patient department. The data were retrospectively analyzed. Results 38 patients were SSe with ILD（SSc-ILD）. 17 patients were SSc without ILD. Patients with SSc-ILD had highe incidences of moderate-high degree of antinuelear antibodies, VC,FVC,FEV1/FVC,DLco. To compare the nailfold microcirculation manifestations of SSc-ILD and SSc without ILD, the ratio of lower definition and indistinct of capillary were higher in SSc-ILD. The ratio of capillary morphological changes and capillary bleeding were high SSc-ILD. Conclusion The characteristics of nailfold microcirculation manifestations in SSc with ILD patients can be helpful for the diagnosis.