Ohtsuka T, Hasegawa A, Nakano A, Yamakage A, Yamaguchi M, Miyachi Y
Department of Dermatology, Dokkyo University School of Medicine, Japan.
Int J Dermatol. 1997 Feb;36(2):116-22. doi: 10.1046/j.1365-4362.1997.00088.x.
Patients with systemic sclerosis (SSC) show a capillary abnormality of nailfolds with controversial correlation with organ involvement. Our purpose was to study the correlation between this nailfold capillary abnormality and pulmonary hypertension in patients with SSC.
We studied the nailfold capillaries, using capillary microscopy, and the pulmonary arterial pressure, using right-heart catheterization, in 44 patients with SSC. Canonical discriminant analysis was used to define the capillary abnormality in patients with SSC, which was then compared with that of 40 normal controls. The correlations between the patterns of nailfold capillaries and the cardiopulmonary findings, including the pulmonary arterial pressure, were examined using Fisher's test.
Thirty-two of 44 patients with SSC could be differentiated from normal controls by our definition of the SSC pattern. The SSC pattern correlated significantly with elevated pulmonary vascular resistance, as well as with pulmonary fibrosis, electrocardiographic abnormalities, decreased vital capacity, and decreased diffusing capacity for carbon monoxide. All SSC patients with pulmonary hypertension showed this SSC pattern. In patients with elevated pulmonary arterial pressure, capillary microscopy and diffusion capacity for carbon monoxide (DCCM) showed the highest rate of abnormalities. A limited-type SSC significantly correlated with DCCM and with anticentromere antibody, and the diffuse-type SSC with pulmonary fibrosis and anti-sci-70 antibody.
Our data suggest that in patients with SSC, nailfold capillary abnormalities correlate with pulmonary arterial hypertension as well as with clinical and laboratory findings indicating pulmonary hypertension.
系统性硬化症（SSC）患者表现出甲襞毛细血管异常，其与器官受累的相关性存在争议。我们的目的是研究SSC患者这种甲襞毛细血管异常与肺动脉高压之间的相关性。
我们对44例SSC患者进行了研究，使用毛细血管显微镜检查甲襞毛细血管，并使用右心导管检查肺动脉压。采用典型判别分析来定义SSC患者的毛细血管异常，然后将其与40名正常对照者的进行比较。使用Fisher检验检查甲襞毛细血管模式与心肺检查结果（包括肺动脉压）之间的相关性。
根据我们对SSC模式的定义，44例SSC患者中有32例可与正常对照者区分开来。SSC模式与肺血管阻力升高、肺纤维化、心电图异常、肺活量降低和一氧化碳弥散能力降低显著相关。所有患有肺动脉高压的SSC患者均表现出这种SSC模式。在肺动脉压升高的患者中，毛细血管显微镜检查和一氧化碳弥散能力（DCCM）显示出最高的异常率。局限性SSC与DCCM和抗着丝点抗体显著相关，弥漫性SSC与肺纤维化和抗scl - 70抗体显著相关。
我们的数据表明，在SSC患者中，甲襞毛细血管异常与肺动脉高压以及表明肺动脉高压的临床和实验室检查结果相关。
