系统性红斑狼疮患者甲襞微循环特点及临床意义

Characteristics and clinical significance of nailfold capillaroscopy in patients with systemic lupus erythematosus

目的总结SLE患者甲襞微循环(NC)特点,并探索其临床意义。方法对162例SLE患者进行NC检查,登记SLE患者的临床资料,使用田牛NC综合评分标准进行NC评分。采用t检验、χ^2检验或Pearson或Spearman相关检验分析。结果142例(87.7%)SLE患者存在NC异常,其中轻、中、重度异常的发生率分别为29.0%(47例)、45.1%(73例)及13.6%(22例)。SLE患者最常见的NC异常表现为血流速度减慢(86.4%)。NC中重度异常的患者伴雷诺现象(37.9%与23.9%,χ^2=2.955,P=0.043)、肺间质病变(8.0%与0,χ^2=5.213,P=0.023)的比例及D-二聚体的水平(1992±2279)μg/L与(1248±1721)μg/L,t=-1.624,P=0.013)高于微循环正常/轻度异常组。相关分析显示雷诺现象(r=0.226,P<0.01;r=0.249,P<0.01)、肺间质病变(r=0.214,P<0.01;r=0.169,P=0.041)与NC异常程度及总积分均呈正相关;肺动脉高压(r=171,P=0.044)及D-二聚体水平(r=0.295,P=0.006)与NC总积分呈正相关,而抗u1RNP抗体阳性与NC异常程度呈正相关(r=214,P=0.016)。结论SLE患者普遍存在NC的异常,以血流速度减慢最常见;NC中重度异常的SLE患者应积极筛查肺动脉高压和肺间质病变。

Objective To summarize the characteristics of nailfold capillaroscopy(NC)in patients with systemic lupus erythematosus(SLE)and explore its clinical significance.Methods NC examination was performed in 162 SLE patients.The clinical data of SLE patients was collected.Tianniu NC scoring standard was used.The t test was applied to analyze the measurement data,theχ^2 test was applied to analyze the counting data.the Pearson or Spearman test was used to evaluate the correlative factors of NC in patients with SLE.Results NC abnormalities were seen in 87.7%(142/162)of SLE patients,and the incidence of mild,moderate and severe abnormalities was 29.0%(47 cases),45.1%(73 cases)and 13.6%(22 cases)respectively.The most common NC abnormal manifestation in SLE patients was decreased blood flow velocity(86.4%).In patients with moderate to severe NC abnormalities,the proportions of patients with Raynaud's phenomenon(37.9%vs 23.9%,χ^2=2.955,P=0.043)and interstitial lung disease(8.0%vs 0,χ^2=5.213,P=0.023),and the level of D-Dimer[(1992±2279)μg/L vs(1248±1721)μg/L,t=-1.624,P=0.013]were significantly higher than those in the groups with normal/mild NC abnormalities.Correlation analysis demonstrated that Raynaud's phenomena,interstitial lung disease,pulmonary hypertension and D-Dimer were positively correlated with the NC abnormality.Conclusion NC abnormalities are common in SLE patients.Decreased blood flow velocity is the most frequent manifestation.SLE patients with moderate to severe NC abnormalities should be actively screened for pulmonary hypertension and interstitial lung disease.