Bredemeier Markus, Xavier Ricardo Machado, Capobianco Karina Gatz, Restelli Vicente Gregório, Rohde Luis Eduardo paim, Pinotti Antônio Fernando Furlan, Pitrez Eduardo Hennemann, Vieira Marcelo Vasconcelos, Fontoura Maria Angela, Ludwig Dolores Heloísa de Campos, Brenol João Carlos Tavares
Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
J Rheumatol. 2004 Feb;31(2):286-94.
To evaluate the association of capillaroscopic alterations with pulmonary disease activity in systemic sclerosis (SSc).
Ninety-one patients with SSc were studied by means of interview, physical examination, nailfold capillary microscopy (NCM), serology, pulmonary function tests, esophageal transit scintigraphy, Doppler echocardiography, and pulmonary high resolution computed tomography (HRCT). Pulmonary disease activity was diagnosed by the observation of ground-glass opacities on pulmonary HRCT. Capillary loss on NCM was evaluated using the avascular score: patients with mean score > or = 1 or mean number of megacapillaries per finger > or = 1 were considered to have severe capillaroscopic alterations.
Patients with higher skin scores, longer disease duration, signs of peripheral ischemia, esophageal dysfunction, antitopoisomerase I antibodies, and ground-glass opacities had higher mean avascular scores (p < or = 0.05 in all tests). The association between ground-glass opacities and higher avascular scores was particularly strong in patients with disease duration < or = 5 years. Among these patients, ground-glass opacities were present in 14 of 19 patients with severe NCM alterations, but were absent in all patients (n = 8) with mild or no NCM alterations (p < 0.001). ROC curves confirmed the ability of NCM to discriminate between patients with and without ground-glass opacities among those with disease duration < or = 5 years. However, NCM could not predict the presence of reduced pulmonary diffusing capacity.
The severity of NCM abnormalities is associated with lung disease activity in SSc, particularly when the disease duration is relatively short.
评估在系统性硬化症（SSc）中毛细血管镜检查改变与肺部疾病活动度的相关性。
通过访谈、体格检查、甲襞毛细血管显微镜检查（NCM）、血清学、肺功能测试、食管通过闪烁扫描、多普勒超声心动图以及肺部高分辨率计算机断层扫描（HRCT）对91例SSc患者进行研究。通过观察肺部HRCT上的磨玻璃影来诊断肺部疾病活动度。使用无血管评分评估NCM上的毛细血管丢失情况：平均评分≥1或每指大毛细血管平均数≥1的患者被认为有严重的毛细血管镜检查改变。
皮肤评分较高、病程较长、有外周缺血体征、食管功能障碍、抗拓扑异构酶I抗体以及磨玻璃影的患者平均无血管评分较高（所有测试中p≤0.05）。在病程≤5年的患者中，磨玻璃影与较高无血管评分之间的关联尤为强烈。在这些患者中，19例有严重NCM改变的患者中有14例存在磨玻璃影，但所有轻度或无NCM改变的患者（n = 8）均无磨玻璃影（p < 0.001）。ROC曲线证实了NCM在病程≤5年的患者中区分有无磨玻璃影患者的能力。然而，NCM无法预测肺弥散功能降低的存在。
NCM异常的严重程度与SSc中的肺部疾病活动度相关，尤其是在病程相对较短时。
