系统性红斑狼疮患者末梢血液改变的激光散斑成像观察

Monitoring of peripheral blood flow in patients with systemic lupus erythematosus by using laser speckle contrast analysis

目的：利用激光散斑衬比分析（LSCA）技术无创性观察分析和评价系统性红斑狼疮（SLE）患者治疗前后末梢血流改变与健康人之间的差异，探讨气温、年龄、性别因素对末梢血流改变的影响。方法收集47例SLE患者第1次就诊时的天气温度（≥20℃组和＜20℃组）、年龄（〈20岁、20-〈40岁、≥40岁组）、性别及血尿常规、补体、抗体免疫学检查等临床资料，依据SLEDAI评分法进行病情评估，与LSCA技术测量的末梢血流改变进行相关性分析，并与30例健康人进行比较。结果47例SLE患者末梢血流甲下为7.017±0.356，甲周为7.821±0.662，与30例健康人（甲下9.765±0.337，甲周3.129±0.128）相比，差异均有统计学意义（t值分别为5.182、5.414，P〈0.05）。SLEDAI评分与甲下及甲周血流改变程度之间存在正相关性（r分别为0.601、0.260， P〈0.05）。随访的28例患者治疗后甲周血流（5.204±0.476）改善明显，与治疗前（7.967±0.913）比较，t=4.644，P〈0.05；甲下血流（7.578±0.554）改善不明显，与治疗前（7.039±0.635）比较，t=2.064，P＞0.05。气温对甲下血流有影响（t=2.415，P〈0.05），对甲周无明显影响（t=0.758，P＞0.05）；性别和年龄对患者甲下及甲周血流的改变影响不明显。结论 SLE患者末梢血流较健康人改变明显，治疗后有一定程度的改善，气温对患者甲下血流改变影响较大。LSCA技术或许可更加便捷、量化地作为SLE患者病情严重程度评价的补充方法。

Objective To noninvasively assess peripheral blood flow changes in patients with systemic lupus erythematosus （SLE） before and after treatments by using laser speckle contrast analysis （LSCA）, to compare eripheral blood flow between SLE patients and healthy controls, and to evaluate effects of air temperature, age and gender on peripheral blood flow changes. Methods Clinical data on air temperature at the first visit （groups of≥20℃and〈20℃）, age（groups of〈20, 20-〈40 and≥40 years）, gender, blood and urine routine test results, complement levels and immunologic test findings were collected from 47 patients with SLE. The patients′ condition was evaluated by systemic lupus erythematosus disease activity index（SLEDAI）, and Spearman′s correlation analysis was carried out to assess its correlation with peripheral blood flow changes（expressed as changes in speckle flow index [△SFI]values）measured by LSCA. Peripheral blood flow was compared between the 47 patients and 30 healthy human controls. Results Compared with healthy controls, SLE patients showed significantly lower subungual SFI values （7.017 ± 0.356 vs. 9.765 ± 0.337, t=5.182, P〈0.05）, but significantly higher periungual SFI values（7.821 ± 0.662 vs. 3.129 ± 0.128, t = 5.414, P 〈 0.05）. SLEDAI scores of patients were positively correlated with both subungual and periungual △SFI values（rs = 0.601, 0.260, respectively, both P 〈 0.05）. A total of 28 patients completed 4-week conventional treatment and follow up, and periungual SFI values significantly decreased in these patients at the end of treatment（5.204 ± 0.476 vs. 7.967 ± 0.913, t=4.644, P〈0.05）, while subungual SFI values experienced no evident changes（7.578 ± 0.554 vs. 7.039 ± 0.635, t=2.064, P〉0.05）compared with those at the baseline. Air temperature affected subungual blood flow significantly（t = 2.415, P 〈 0.05）, but had no significant effects on periungual blood flow（t=0.758, P〉0.05）. In addition, neither gender nor age had obvious effects on subungual or periungual blood flow. Conclusions Compared with healthy controls, peripheral blood flow significantly changed in patients with SLE,and was improved to a certain extent after treatment. Air temperature markedly affects subungual blood flow. LSCA may be a supplementary approach to more convenient and quantitative assessment of the severity of SLE.