Gunawardena H, Harris N D, Carmichael C, McHugh N J
Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, BA1 1RL, UK.
Rheumatology (Oxford). 2007 Jul;46(7):1079-82. doi: 10.1093/rheumatology/kem085. Epub 2007 May 9.
Objectives. To investigate microvascular function using laser Doppler imaging (LDI) following response to hyperaemia, neurovascular reflex and iontophoresis in systemic sclerosis (SSc) in comparison with primary Raynaud's phenomenon (PRP) and age-matched controls. A secondary aim was to evaluate if SSc patients with a higher Medsger vascular score have lower endothelial responses. Methods. Twenty patients with SSc, 10 PRP and 17 controls were studied. Patients with SSc were scored using the vascular component of the Medsger severity scale. A baseline LDI scan was performed on the dorsal aspect of both hands. Digital responses were quantified following maximum hyperaemic response (MHR), contralateral vasoconstrictor response (CLVc) and iontophoresis with acetylcholine (Ach)-endothelial dependent and sodium nitroprusside (SNP)-endothelial independent. Mean blood flow was quantified over a standard region of interest. Results. MHR was lower in SSc patients compared with controls (P < 0.001). A similar trend was seen when comparing SSc with PRP although this did not reach significance (P = 0.07). CLVc and Ach/MHR were lower in SSc vs PRP (P < 0.05) and controls (P < 0.001). No difference was observed in MHR, CLVc and Ach/MHR between PRP and controls. Overall, SNP/MHR was similar in all the three groups. SSc patients with a higher Medsger vascular score had lower endothelial-dependent (P < 0.01) and independent (P < 0.05) responses. Conclusion. SSc patients have abnormal microvascular regulatory responses compared with PRP and controls. This study also suggests that the degree of endothelial dysfunction may be related to the degree of peripheral vascular involvement.
目的。与原发性雷诺现象（PRP）及年龄匹配的对照组相比，利用激光多普勒成像（LDI）研究系统性硬化症（SSc）患者在充血反应、神经血管反射及离子电渗疗法后的微血管功能。第二个目的是评估梅斯杰血管评分较高的SSc患者是否具有较低的内皮反应。方法。研究了20例SSc患者、10例PRP患者及17例对照者。使用梅斯杰严重程度量表的血管部分对SSc患者进行评分。在双手背侧进行基线LDI扫描。在最大充血反应（MHR）、对侧血管收缩反应（CLVc）以及乙酰胆碱（Ach）离子电渗疗法（内皮依赖性）和硝普钠（SNP）离子电渗疗法（非内皮依赖性）后对指端反应进行量化。在标准感兴趣区域对平均血流进行量化。结果。与对照组相比，SSc患者的MHR较低（P < 0.001）。将SSc与PRP进行比较时也观察到类似趋势，尽管未达到统计学显著性（P = 0.07）。与PRP及对照组相比，SSc患者的CLVc和Ach/MHR较低（P < 0.05和P < 0.001）。PRP与对照组之间在MHR、CLVc和Ach/MHR方面未观察到差异。总体而言，三组的SNP/MHR相似。梅斯杰血管评分较高的SSc患者具有较低的内皮依赖性（P < 0.01）和非依赖性（P < 0.05）反应。结论。与PRP和对照组相比，SSc患者具有异常的微血管调节反应。本研究还表明内皮功能障碍程度可能与外周血管受累程度相关。
