Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties (DiMI), University of Genova-IRCCS San Martino Polyclinic Hospital, Genoa, Italy.
Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
Nat Rev Rheumatol. 2021 Nov;17(11):665-677. doi: 10.1038/s41584-021-00685-0. Epub 2021 Sep 24.
Morphological and functional analysis of the microcirculation are objective outcome measures that are recommended for use in the presence of clinical signs of altered peripheral blood flow (such as Raynaud phenomenon), which can occur in systemic sclerosis (SSc) and other autoimmune rheumatic diseases. Several advanced non-invasive tools are available for monitoring the microcirculation, including nailfold videocapillaroscopy, which is the best-studied and most commonly used method for distinguishing and quantifying microvascular morphological alterations in SSc. Nailfold videocapillaroscopy can also be used alongside laser Doppler techniques to assist in the early diagnosis and follow-up of patients with dermatomyositis or mixed connective tissue disease. Power Doppler ultrasonography, which has been used for many years to evaluate the vascularity of synovial tissue in rheumatoid arthritis, is another promising tool for the analysis of skin and nailbed capillary perfusion in other autoimmune rheumatic diseases. Other emerging methods include raster-scanning optoacoustic mesoscopy, which offers non-invasive high-resolution 3D visualization of capillaries and has been tested in psoriatic arthritis and SSc. The principle functions and operative characteristics of several non-invasive tools for analysing microvascular changes are outlined in this Review, and the clinical roles of validated or tested imaging methods are discussed for autoimmune rheumatic diseases.
微循环的形态学和功能分析是客观的结局指标，建议在存在外周血流改变的临床体征（如雷诺现象）时使用，这些体征可发生在系统性硬化症（SSc）和其他自身免疫性风湿病中。有几种先进的非侵入性工具可用于监测微循环，包括甲襞微血管镜检查，这是研究最多和最常用的方法，可用于区分和量化 SSc 中的微血管形态改变。甲襞微血管镜检查还可以与激光多普勒技术一起用于协助早期诊断和随访皮肌炎或混合性结缔组织病患者。功率多普勒超声检查多年来一直用于评估类风湿关节炎滑膜组织的血管生成，是另一种有前途的工具，可用于分析其他自身免疫性风湿病中的皮肤和甲床毛细血管灌注。其他新兴方法包括光栅扫描光声介观成像术，它可提供毛细血管的非侵入性高分辨率 3D 可视化，已在银屑病关节炎和 SSc 中进行了测试。本综述概述了几种用于分析微血管变化的非侵入性工具的主要功能和操作特点，并讨论了经过验证或测试的成像方法在自身免疫性风湿病中的临床作用。
