系统性硬化病甲襞微循环特点及其临床意义

Characteristics of nailfold capillaroscopy examination of systemic sclerosis and its value in assessing the development of SSc

目的通过比较SSc和其他CTD患者甲襞微循环的差异,探讨SSc患者甲襞微循环的特点,进一步分析甲襞微循环改变与脏器受累的关系,阐明甲襞微循环在SSc病情监测中的意义。方法①收集60例SSc患者和55例其他CTD患者,记录所有患者的人口学资料,以及胸部CT、肺功能、心脏超声等检查以及实验室检查结果,进行修订的Rodnan皮肤评分(mRSS)。所有患者均行甲襞微循环检查。②采用Cutolo定性评估方法、半定量评分系统和"田牛甲襞微循环加权积分法"评估SSc组和其他CTD组患者甲襞微循环检查结果,探讨SSc甲襞微循环的特点。③分析甲襞微循环改变与SSc患者关节受累、内脏受累以及自身抗体之间的关系。④采用t检验、χ^(2)检验或秩和检验分析,以P<0.05为差异有统计学意义。结果①SSc和其他CTD患者甲襞微循环Cutolo定性评估结果比较,SSc组患者甲襞微循环异常例数(52例)比其他CTD组明显增多(21例),活动期和晚期所占的比例升高(占63%),差异具有统计学意义(Z=-3.853,P<0.01)。②SSc和其他CTD患者甲襞微循环半定量评分结果显示:SSc组患者与其他CTD组比较,毛细血管数量评分[(1.67±0.60)和(0.72±0.46),t=8.347,P<0.01]、不规则扩大的毛细血管评分[(1.22±0.88)与(0.74±0.50),t=3.178,P<0.01]、微出血评分[(0.30±0.39)与(0.10±0.21),t=3.090,P<0.01]、毛细血管排列失规则评分[(0.38±0.38)与(0.18±0.32),t=2.729,P<0.01],差异具有统计学意义。③SSc和其他CTD患者甲襞微循环"田牛甲襞微循环加权积分法"评估结果显示,SSc患者管袢数明显减少(Z=-4.194,P<0.01),输入支管径(t=3.704,P<0.01)、输出支管径(t=3.913,P<0.01)、袢顶直径均明显增宽(t=4.586,P<0.01),畸形管袢数比例(Z=-2.677,P<0.01)、巨型管袢增多(χ^(2)=8.040,P=0.013),袢周渗出(Z=-2.278,P=0.023)较其他CTD组明显增多,差异具有统计学意义。④甲襞微循环改变与脏器受累的关系:有呼吸系统受累的SSc患者,甲襞微循环活动期和晚期所占的比例(66%,33/50)高,而无呼吸系统受累的患者早期和活动期(60%,6/10)所占的比例高,差异具有统计学意义(Z=10.114,P=0.045)。有关节受累的SSc患者,甲襞微循环75%(12/16)表现为活动期和晚期,而无关节受累的患者,66%(229/44)表现为早期和活动期(Z=5.550,P=0.057)。结论与其他CTD相比,SSc患者甲襞微循环具有特征性,甲襞微循环异常改变与呼吸系统受累相关,可作为评价病情的客观指标。

Objective To identify the characteristics of nailfold capillaroscopy(NFC)of systemic sclerosis(SSc)and investigate whether more severe peripheral microangiopathy at NFC were related to the development of SSc.Methods①The study included 115 patients(60 cases with SSc and 55 patients with other connective tissue diseases).All patients were treated with neither prednisone nor immunosuppressive drugs within 3 months before enrollment.We collected the following data:age,disease duration,disease onset,mRSS,high-resolution chest tomography(HRCT),echocardiography,pulmonary function,nailfold capillaroscopy and routine laboratory assessments.②All the NFC definitions were used for semi-quantitatively scoring and Cutolo's qualitative assessment.③The relationship between NFC changes and joint,visceral involvement and autoantibodies in SSc patients was analyzed.④T test,Rank sum test and chi-square test were applied to analyze data.Results①According to Cutoloqualitative assessment of NFC,patients of SSc with active/late pattern(n=52)were very common than other CTD(n=21)(Z=-3.853,P<0.01).②According to semiquantitative assessment,the scores of loss of capillaries[(1.67±0.60)vs(0.72±0.46),t=8.347,P<0.01],irregular enlarged capillaries[(1.22±0.88)vs(0.74±0.50),t=3.178,P<0.01],hemorrhage[(0.30±0.39)vs(0.10±0.21),t=3.090,P<0.01],disorganization of the microvascular array[(0.38±0.38)vs(0.18±0.32),t=2.729,P<0.01]were significantly higher than CTD.③The NFC of SSc patients was significantly different from CTD.The number of capillary loss(Z=-4.194,P<0.01),input capillary dimensions(t=3.704,P<0.01),output capillary dimensions(t=3.913,P<0.01),wide diameter of capillary(t=4.586,P<0.01),tortuous capillaries(Z=-2.677,P<0.01),gaint capillary(χ^(2)=8.040,P=0.013),effusion(Z=-2.278,P=0.023)were more increased than CTD.④The NFC pattern of SSc with lung involvement were mainly active and late(66%,33/50),whereas early and active pattern(60%,6/10)for those without respiratory system involvement(Z=10.114,P=0.045).The NFC pattern of SSc patients with joint involvement were mainly active and late(75%,12/16),whereas early and active(66%,29/44)for those without joint involvement(Z=5.550,P=0.057).Conclusion The NFC of SSc patients is significantly different from CTD.NFC may be a suitable tool for disease evaluation.