Sulli Alberto, Soldano Stefano, Pizzorni Carmen, Montagna Paola, Secchi Maria Elena, Villaggio Barbara, Seriolo Bruno, Brizzolara Renata, Cutolo Maurizio
Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132 Genova, Italy.
J Rheumatol. 2009 Jun;36(6):1235-9. doi: 10.3899/jrheum.081030. Epub 2009 Apr 15.
We evaluated endothelin (ET)-1 plasma levels and some clinical measures in patients with primary Raynaud's phenomenon (PRP), and in patients with systemic sclerosis (SSc) and secondary RP (SRP), in the latter according to their different nailfold videocapillaroscopy (NVC) patterns of microangiopathy (early, active, and late).
Ninety-nine patients with SSc, 49 with PRP, and 45 control subjects were studied. NVC was performed in all patients to distinguish the pattern of microvascular damage, and the morphological alterations were scored by a semiquantitative rating scale. ET-1 plasma levels were evaluated in all individuals by ELISA.
ET-1 plasma levels were significantly higher (p=0.001) in patients with both PRP and SRP, compared to controls. A significant positive correlation (p=0.03) was found between ET-1 plasma levels and SRP duration, but not between ET-1 plasma levels and PRP duration. Significant correlations were observed in patients with SSc between ET-1 plasma levels and clinical measures (e.g., digital ulcers), as well as the score value of single NVC measures, such as the number of capillaries, "ramified" capillaries, and enlarged capillaries (p<0.05). Finally, the highest ET-1 plasma levels were found in patients with SSc showing the late pattern of microangiopathy when compared to the early pattern (p=0.03) and to controls (p=0.003).
Highest ET-1 plasma levels were detected in the more advanced stage of the SSc microangiopathy, namely the late NVC pattern, characterized by capillary loss and increased tissue fibrosis; this might support the involvement of ET-1 in the progression of the microvascular/fibrotic SSc damage.
我们评估了原发性雷诺现象（PRP）患者、系统性硬化症（SSc）患者以及继发性雷诺现象（SRP）患者的血浆内皮素（ET）-1水平和一些临床指标，对于SRP患者，根据其不同的甲襞微血管镜检查（NVC）微血管病变模式（早期、活动期和晚期）进行评估。
研究了99例SSc患者、49例PRP患者和45例对照受试者。对所有患者进行NVC以区分微血管损伤模式，并通过半定量评分量表对形态学改变进行评分。通过酶联免疫吸附测定法（ELISA）评估所有个体的血浆ET-1水平。
与对照组相比，PRP和SRP患者的血浆ET-1水平显著更高（p = 0.001）。血浆ET-1水平与SRP病程之间存在显著正相关（p = 0.03），但与PRP病程之间无相关性。在SSc患者中，观察到血浆ET-1水平与临床指标（如指端溃疡）以及单个NVC指标的评分值（如毛细血管数量、“分支状”毛细血管和扩张的毛细血管）之间存在显著相关性（p < 0.05）。最后，与早期模式（p = 0.03）和对照组（p = 0.003）相比，表现为微血管病变晚期模式的SSc患者血浆ET-1水平最高。
在SSc微血管病变的更晚期阶段，即晚期NVC模式（其特征为毛细血管丧失和组织纤维化增加）中检测到最高的血浆ET-1水平；这可能支持ET-1参与了SSc微血管/纤维化损伤的进展。
