Clinic of Rheumatology, Medical University, Plovdiv, Bulgaria.
Microvasc Res. 2010 Dec;80(3):534-9. doi: 10.1016/j.mvr.2010.07.005. Epub 2010 Jul 21.
Мicrocirculation is the main environment of the pathologic processes in systemic sclerosis (SSc). Nailfold capillaroscopic abnormalities in SSc are highly specific. It is well known that capillaroscopic examination reveals different changes in the different stages of SSc. Dilated, single giant capillaries and haemorrhages, preserved arrangement are the characteristic features of the "early" capillaroscopic phase; frequent giant capillaries and haemorrhages are the findings in the "active" phase, while in the "late" stages extensive avascular areas are usually found. Although tissue hypoxia normally is a strong inducer of neovascularization, there is no evidence of significant vascular recovery in SSc patients. Formation of new blood vessels is possible through two different mechanisms - angiogenesis (formation of new vessels from differentiated endothelial cells of prior vessels) - and vasculogenesis (from endothelial progenitor cells-EPCs). Disturbed function of EPCs has been found in all the stages of the disease. Only EPCs from SSc patients in the early phase of the disease have shown preserved ability for differentiation and maturation to endothelial cells in vitro. The recovery of the injured microvessels is also disturbed due to a predominance of angiogenic inhibitors. The capillaroscopic changes in the different stages of SSc mirror the dynamics in processes of angio- and vasculogenesis. The formation of new capillaries after therapeutic influence of vascular recovery by transplantation of autologous bone-marrow derived stem cells supports this conclusion.
微循环是系统性硬化症（SSc）中病理过程的主要环境。SSc 的甲褶毛细血管镜异常具有高度特异性。众所周知，毛细血管镜检查显示 SSc 的不同阶段有不同的变化。扩张的、单一的巨大毛细血管和出血、保留的排列是“早期”毛细血管相的特征性特征；频繁的巨大毛细血管和出血是“活跃”阶段的发现，而在“晚期”阶段通常发现广泛的无血管区。尽管组织缺氧通常是促血管新生的强诱导剂，但 SSc 患者没有证据表明有明显的血管恢复。新血管的形成可能通过两种不同的机制发生 - 血管生成（从先前血管的分化内皮细胞形成新血管）和血管发生（从内皮祖细胞-EPCs）。在疾病的所有阶段都发现了 EPC 功能障碍。只有 SSc 患者在疾病的早期阶段的 EPCs 显示出在体外分化和成熟为内皮细胞的能力得到保留。由于血管生成抑制剂的优势，受伤的微血管的恢复也受到干扰。SSc 不同阶段的毛细血管变化反映了血管生成和血管发生过程的动力学。在通过移植自体骨髓来源的干细胞进行血管恢复的治疗作用后形成新的毛细血管，支持了这一结论。
