Lambova Sevdalina, Müller-Ladner Ulf
Clinic of Rheumatology, Department for Propaedeutics of Internal Medicine, Medical University, Plovdiv, Bulgaria.
Discov Med. 2011 Nov;12(66):413-8.
The aim of the study was to evaluate capillaroscopic pattern in systemic sclerosis (SSc) patients and its association with disease duration as well as with presence of digital ulcers.
Thirty six patients with SSc were included in the study. The severity of Raynaud's phenomenon (RP) at the hands was assessed with VAS (100mm), and the presence of digital ulcers at the hands was documented. Nailfold capillaroscopy was performed by a videocapillaroscope.
RP was found as a clinical symptom in 100% (36/36) of the examined SSc patients. In SSc patients with a duration of the disease of less than 3 years, an early phase "scleroderma type" capillaroscopic pattern was found in 50% (5/10) of the cases. In the group of SSc patients with a duration of the disease of more than 3 years, late phase scleroderma type capillaroscopic pattern was found in 26.9% (7/26) of the cases, which was characterized by the presence of extensive, "desert-like" avascular areas and neoangiogenic capillaries. Scleroderma type capillaroscopic pattern was found in 97.2% (35/36) of the cases. Digital ulcers at the hands were found in 36.1% (13/36) of the patients. In 100% of those patients with digital ulcers (13/13), an active type scleroderma like pattern was observed, which is characterized by the presence of frequent giant capillaries, hemorrhages, and avascular areas. An active type scleroderma like pattern was found in 47.2% (17/36) of the patients without digital ulcers.
The data show that the presence of digital ulcers at the hands of SSc patients is strongly associated with an active type scleroderma like capillaroscopic pattern. Observation of an active type scleroderma like pattern in patients without digital ulcers may therefore be used as a predictor for the development of trophic changes in the future, an indication for vasoactive medication for the prevention of the development of digital ulcers, and as an additional objective method for the evaluation of disease activity score in SSc.
本研究旨在评估系统性硬化症（SSc）患者的甲襞毛细血管镜检查模式及其与疾病持续时间以及手指溃疡存在情况的关联。
36例SSc患者纳入本研究。采用视觉模拟评分法（VAS，100mm）评估手部雷诺现象（RP）的严重程度，并记录手部是否存在手指溃疡。通过视频毛细血管镜进行甲襞毛细血管镜检查。
100%（36/36）的受检SSc患者存在RP这一临床症状。在疾病持续时间小于3年的SSc患者中，50%（5/10）的病例发现早期“硬皮病型”毛细血管镜检查模式。在疾病持续时间超过3年的SSc患者组中，26.9%（7/26）的病例发现晚期硬皮病型毛细血管镜检查模式，其特征为存在广泛的“沙漠样”无血管区和新生血管性毛细血管。97.2%（35/36）的病例发现硬皮病型毛细血管镜检查模式。36.1%（13/36）的患者手部存在手指溃疡。在所有有手指溃疡的患者（13/13）中，均观察到活跃型硬皮病样模式，其特征为频繁出现巨大毛细血管、出血和无血管区。在无手指溃疡的患者中，47.2%（17/36）发现活跃型硬皮病样模式。
数据表明，SSc患者手部手指溃疡的存在与活跃型硬皮病样毛细血管镜检查模式密切相关。因此，在无手指溃疡的患者中观察到活跃型硬皮病样模式可作为未来营养改变发展的预测指标、使用血管活性药物预防手指溃疡发展的指征以及评估SSc疾病活动评分的额外客观方法。
