系统性硬化病患者甲襞毛细血管的特点及其与其他结缔组织病的比较  

The features of nail fold capiUaroscopy of systemic sclerosis patients and comparison between systemicsclerosis patients and patients with other connective tissue diseases

作　　者：徐雪[1] 朱小霞[1] 薛愉[1] 宣丹旦[1] 万伟国[1] 宋萌萌[2] 吴文育[2] 邹和建[1] 

机构地区：[1]复旦大学附属华山医院风湿科,上海200040 [2]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中华风湿病学杂志》2012年第8期512-517,F0003,共7页Chinese Journal of Rheumatology

基　　金：上海市科学技术委员会优秀学术带头人项目（11XDl401100）

摘　　要：目的观察系统性硬化病（SSc）患者甲襞微循环的特点及其与其他结缔组织病（CTD）患者甲襞毛细血管镜下表现的差异。方法选取40例SSc患者和37例其他CTD的患者，所有患者均伴有雷诺现象，行甲襞毛细血管镜检查，比较SSc患者甲襞微循环各项指标与其他CTD患者之间的差异，并与疾病的临床和实验室参数进行相关分析，采用方差分析和t检验膏检验。结果SSc患者甲襞微循环的主要特点是管袢数目减少，管袢扩张，畸形管袢增多，出现不同程度的皮下出血以及毛细血管新生等；SSc患者毛细血管镜的某些指标较其他CTD患者更严重，更具有特异性。伴有肺部或食管累及的SSc患者甲襞毛细血管镜总积分（肺部累及：13±5，食管累及：14±7）明显高于无上述器官累及者（无肺部累及：7±5，无食管累及：6±5，P〈0．01）；抗Scl-70抗体阳性的SSc患者甲襞毛细血管镜总积分明显高于抗体阴性组（14±9，6±5，P〈0．05）。结论SSc患者甲襞微循环表现具有特异性，甲襞微循环异常程度与临床免疫学指标有一定关系，提示毛细血管镜检查是评价SSc微血管病变的重要手段，可为鉴别SSc和其他CTD的提供参考意见，并可望作为评价疾病严重性的客观指标。Objective The aim of the study was to observe the features of nail fold microcirculation in systemic sclerosis （SSc） patients and to compare these findings in SSc patients with patients with other connective tissue diseases. Methods Forty patients with SSc and thirty-seven patients with other connective tissue diseases were included in the study and all the patients reported symptoms of Raynaud＇s phenomenon in the hands were also included. Nail fold capillaroscopy （NFC） was performed and the abnormality of nail fold microcirculation between the two groups were compared. The relations between nail fold capillaroscopic findin- gs and clinicolaboratory parameters in SSc patients were analyzed. Statistical 9nalysis were carried out by t-test and Chi-square. Results The loss of capillaries and dilated and giant capillaries and hemorrhage as well as neoangiogenesis were hallmarks of the scleroderma capillary findings, which could be detected by nail fold capillaroscopy. The abnormalities of nail fold microcirculation in SSc patients were more severe and more specific than those in other connective tissue disease patients. The total scores of nail fold capiilaroscopy test were obviously higher in SSc patients with lung or esophagus involvement than those patients without these organ involvement, meanwhile, the total scores of nail fold capillaroseopic findings were elevated in SSc patients with anti-Scl70 antibody than those with negative group. Conclusion The nail fold capillaries of patients with SSc have specific abnormalities, and nail fold capill-aroscopy could distinguish between SSc and other connective tissue diseases, therefore it could be used as a promising tool for early detection of patients who mac have the potential to develop scleroderma and it is also helpful in assessing disease severity.

关 键 词：系统性硬化 结缔组织病 甲襞毛细血管镜 雷诺现象 甲襞微循环 

分 类 号：R593.2[医药卫生—内科学]