Scagliusi P, Scardigno A, Marsico A, Anelli F, Petruzzellis V, Pipitone V
Minerva Med. 1984 Jan 28;75(3-4):91-8.
Capillarioscopy has been unjustifiably neglected in the study of connective tissue diseases, where examination of the microcirculation is clearly important. A study of 80 cases is reported. 12 systemic lupus, 11 progressive systemic sclerosis (PSS), 20 rheumatoid arthritis (including 3 juvenile and 2 Still's disease); 9 Raynaud's disease (of which 3 idiopathic, 4 with rheumatoid arthritis and 2 with UCTD); 1 dermatomyositis; 11 other CTD (2 overlap syndrome--1 lupus + dermatomyositis; 1 lupus + PSS--3 Sjögren syndromes with rheumatoid arthritis, 1 MCTD, 2 primary mixed cryoglobulinaemia, 1 systemic vasculitis, 1 Behçet syndrome, and 1 UCTD); 9 miscellaneous forms (3 psoriatic arthropathy, 1 rheumatic pelvispondylitis, 1 allergic dermatitis, 1 pulmonary TB, 1 ulcerative colitis; 1 scapulohumeral periarthritis, 1 unclassifiable rheumatism; 7 healthy subjects). During capillarioscopy, from one to nine slides were prepared for each subject. These were interpreted separately by three persons who were unaware of the respective diagnosis. Calibre, tortuosity, length and number of capillaries were recorded, plus the visibility of the subpapillar plexus, height and number of the termal, subungual and/or ungual vallum haemorrhage, plugging. It was found that PSS, dermatomyositis, MCTD, and overlap-PSS revealed a very typical common pattern, possibly pathognomonic, namely marked reduction in the number of capillaries + megacapillaries. The other forms presented less evocative diagnostic patterns, though they were fairly indicative in some instances. Clinical correlations of particular significance with respect to prognosis, however, were not observed.
在结缔组织疾病的研究中,毛细血管镜检查一直被无端忽视,而微循环检查显然很重要。本文报告了一项对80例患者的研究。其中12例系统性红斑狼疮,11例进行性系统性硬化症(PSS),20例类风湿性关节炎(包括3例青少年型和2例斯蒂尔病);9例雷诺病(其中3例特发性,4例合并类风湿性关节炎,2例合并未分化结缔组织病(UCTD));1例皮肌炎;11例其他结缔组织病(2例重叠综合征——1例狼疮 + 皮肌炎;1例狼疮 + PSS——3例合并类风湿性关节炎的干燥综合征,1例混合性结缔组织病(MCTD),2例原发性混合性冷球蛋白血症,1例系统性血管炎,1例白塞病,1例UCTD);9例其他类型(3例银屑病关节炎,1例风湿性骨盆脊柱炎,1例过敏性皮炎,1例肺结核,1例溃疡性结肠炎;1例肩胛肱骨周围炎,1例无法分类的风湿病;7例健康受试者)。在进行毛细血管镜检查时,为每位受试者准备了1至9张玻片。由三名不知各自诊断结果的人员分别进行解读。记录毛细血管的管径、迂曲度、长度和数量,以及乳头下血管丛的可见度、甲周、甲下和/或甲壁出血的高度和数量、堵塞情况。研究发现,PSS、皮肌炎、MCTD和重叠性PSS呈现出一种非常典型的共同模式,可能具有病理诊断意义,即毛细血管和大毛细血管数量显著减少。其他类型呈现出的诊断模式不那么具有提示性,不过在某些情况下也颇具指示性。然而,未观察到与预后具有特别显著意义的临床相关性。