Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
Respir Res. 2021 Jan 21;22(1):27. doi: 10.1186/s12931-021-01622-1.
Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity.
Α prospective case-control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal-Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test).
Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 μm and 15.8 ± 1.9 μm vs. 11.5 ± 2.3 μm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001).
The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.
尽管多年来肺动脉血管床一直是肺动脉高压（PH）研究的主要对象，但最近人们开始关注可能存在共存的外周微血管病变。本研究旨在探讨在毛细血管前 PH 患者中是否存在甲襞视频毛细血管镜（NVC）结构变化，并确定 NVC 测量与疾病严重程度标志物的可能关联。
进行了一项前瞻性病例对照研究，纳入 28 例毛细血管前 PH 患者（14 例特发性肺动脉高压（IPAH）和 14 例慢性血栓栓塞性肺动脉高压（CTEPH））和 30 名健康对照者。使用 Optilia 数字毛细血管镜评估 NVC 定量和定性参数。为了确保观察者间的可重复性，由两名独立研究者审查了毛细血管镜图像。对于连续变量的多重比较，使用单向方差分析或 Kruskal-Wallis 检验。使用事后分析（Bonferroni 检验）进行组间比较。
IPAH 组（71.4%为女性，平均年龄 53.1±13.4 岁）和 CTEPH 组（64.3%为女性，平均年龄 60.9±14.4 岁）的毛细血管密度均低于健康对照组（8.4±1.2 个环/mm 和 8.0±1.2 个环/mm 比 9.7±0.81 个环/mm，p<0.001），且环宽度增加（15.7±3.9μm 和 15.8±1.9μm 比 11.5±2.3μm，p<0.001）。超过一半的 IPAH 患者的甲襞毛细血管出现微出血，而 CTEPH 患者的毛细血管形态异常和每线性毫米的毛细血管血栓增加则比 IPAH 患者和健康对照组更明显。与对照组相比，所有 PH 患者的 NVC 模式均存在非特异性改变（p<0.001）。
研究结果显示 IPAH 和 CTEPH 患者存在一定程度的外周微血管显著改变，提示肺血管疾病外周微血管普遍受损。
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