Rheumatology Division, Universidade Federal de São Paulo, São Paulo, Brazil.
Clin Exp Rheumatol. 2013 Mar-Apr;31(2 Suppl 76):103-8. Epub 2013 Jan 16.
Peripheral microangiopathy is a hallmark of systemic sclerosis (SSc) and can be early detected by nailfold capillaroscopy (NFC). This study aimed to examine whether more severe peripheral microangiopathy at NFC are predictive factor for death in SSc patients.
135 SSc patients who performed NFC between June 2001 and July 2009 were included. The following NFC parameters were evaluated: number of capillary loops/mm, avascular score (scored from 0 to 3), and number of enlarged and giant capillary loops. Univariate and multivariate regression models were used to analyse the association of mortality with NFC and clinical parameters.
At the time of the analysis (August 2010), 123 patients were alive, and 12 were dead. By univariate analysis, male gender, forced vital capacity <75% predicted, higher number of giant capillary loops, and an avascular score >1.5 on NFC were associated with a significantly increase risk of death. By multivariate analysis, an avascular score >1.5 was the only independent predictor of death (hazard ratio 2.265). Survival rates from diagnosis at 1, 5 and 10 years were lower in patients with avascular score >1.5 (97%, 86%, and 59%, respectively) compared with those with avascular score ≤1.5 (97%, 97%, and 91% respectively) (p=0.009 by log rank test).
Avascular scores higher than 1.5 at NFC was an independent predictor of death in SSc, suggesting that NFC can be useful for predicting SSc outcome.
周围微血管病变是系统性硬化症（SSc）的标志，可以通过甲襞毛细血管显微镜检查（NFC）早期发现。本研究旨在探讨 NFC 中更严重的周围微血管病变是否是 SSc 患者死亡的预测因素。
纳入 2001 年 6 月至 2009 年 7 月期间进行 NFC 的 135 例 SSc 患者。评估以下 NFC 参数：毛细血管环/mm 的数量、无血管评分（评分 0-3 分）和增大及巨大毛细血管环的数量。使用单变量和多变量回归模型分析 NFC 和临床参数与死亡率的相关性。
在分析时（2010 年 8 月），123 例患者存活，12 例死亡。单变量分析显示，男性、用力肺活量<75%预计值、较多的巨大毛细血管环和 NFC 上的无血管评分>1.5 与死亡风险显著增加相关。多变量分析显示，无血管评分>1.5 是死亡的唯一独立预测因素（危险比 2.265）。无血管评分>1.5 的患者从诊断开始的 1、5 和 10 年生存率分别较低（分别为 97%、86%和 59%），而无血管评分≤1.5 的患者分别为 97%、97%和 91%（对数秩检验，p=0.009）。
NFC 中无血管评分高于 1.5 是 SSc 死亡的独立预测因素，提示 NFC 可用于预测 SSc 结局。
