Division of Angiology, Department of Medicine II, Medical University of Vienna , Austria.
Scand J Rheumatol. 2014;43(3):226-33. doi: 10.3109/03009742.2013.847118. Epub 2014 Feb 12.
Nailfold capillaroscopy (NC) and laboratory tests for antinuclear antibodies (ANA) are routinely used in parallel for detection of emerging connective tissue disease (CTD) in patients with Raynaud's phenomenon (RP). The aim of this study was to assess the associations between distinct nailfold capillary abnormalities and concomitant autoantibodies in patients with incipient RP without previously known CTD.
Patients with incipient RP without previously known CTD were included in this retrospective analysis. We analysed the association of particular capillary abnormalities (reduced density, avascular fields, dilations, giant capillaries, haemorrhages, tortuosity, ramifications, oedema) with ANA and ANA subsets (anti-Scl-70, anti-CENP-B, anti-U1-RNP, anti-dsDNA, anti-SSA(Ro), anti-SSB(La), anti-Sm, and anti-Jo-1 antibodies). We also developed a score that allows the estimation of each patient's individual probability for the presence of an ANA titre ≥ 1:160.
The final analysis comprised 2971 patients. Avascular fields, giant capillaries, reduced capillary density, and capillary oedema were closely related to an ANA titre ≥ 1:160. Both giant capillaries and avascular fields were associated with anti-Scl-70 and anti-CENP-B antibodies. Only a weak association was found between giant capillaries and anti-U1-RNP antibodies. Each patient's individual probability for the presence of an ANA titre ≥ 1:160 can be represented by a sum score comprising giant capillaries, reduced density, avascular fields, ramifications, and oedema as well as patients' sex and age.
In patients with incipient RP, anti-Scl-70 and anti-CENP-B antibodies are related most specifically to distinct capillary alterations. Although a sum score can represent the patient's probability for elevated ANA titres, NC cannot substitute for immunological tests in patients with incipient RP.
甲襞毛细血管显微镜检查（NC）和抗核抗体（ANA）实验室检测常用于并行检测有雷诺现象（RP）的患者中新发结缔组织病（CTD）。本研究的目的是评估初发 RP 患者中不同甲襞毛细血管异常与同时存在的自身抗体之间的相关性，这些患者此前没有已知的 CTD。
本回顾性分析纳入了初发 RP 且此前没有已知 CTD 的患者。我们分析了特定毛细血管异常（密度降低、无血管区、扩张、巨毛细血管、出血、扭曲、分支、水肿）与 ANA 和 ANA 亚类（抗 Scl-70、抗 CENP-B、抗 U1-RNP、抗 dsDNA、抗 SSA(Ro)、抗 SSB(La)、抗 Sm 和抗 Jo-1 抗体）之间的关联。我们还开发了一个评分系统，可以估计每位患者存在 ANA 滴度≥1:160 的个体概率。
最终分析包括 2971 名患者。无血管区、巨毛细血管、毛细血管密度降低和毛细血管水肿与 ANA 滴度≥1:160 密切相关。巨毛细血管和无血管区均与抗 Scl-70 和抗 CENP-B 抗体相关。仅发现巨毛细血管与抗 U1-RNP 抗体之间存在微弱关联。每位患者存在 ANA 滴度≥1:160 的个体概率可以用一个总分来表示，该总分包括巨毛细血管、密度降低、无血管区、分支和水肿以及患者的性别和年龄。
在初发 RP 患者中，抗 Scl-70 和抗 CENP-B 抗体与特定的毛细血管改变最相关。尽管总分可以代表患者升高的 ANA 滴度的概率，但 NC 不能替代初发 RP 患者的免疫学检测。
