The Clinical Significance Of Microcirculation In The Treatment Of Connective Tissue Disease Associated With Pulmonary Hypertension

Objective:Connective tissue disease(CTD)is an autoimmune disease that can do harm to many organs and systems.Pulmonary hypertension is one of the most serious complications of CTD.It is one of the main causes of death in CTD patients with cryptic beginning symptoms,and it is difficult to be diagnosed clinically.Vascular inflammation and proliferation of connective tissue disease associated pulmonary arterial hypertension(CTD-PAH)are receiving increasing attention in the pathogenesis of CTD-PAH.Microcirculation technique is a technique that can observe vascular lesions directly.There is little research on the correlation between microcirculation and systemic lupus erythematosus and systemic sclerosis pulmonary hypertension(PAH),and it is also at the beginning overseas without consistent conclusion.As a noninvasive,simple and objective method,the microcirculation detection technique was proposed by Professor Li Guoxian in 1990.This method combines the traditional Chinese medicine prospecting method and the theory of conjunctival conjunctiva microcirculation,which is a kind of method for judging blood stasis syndrome recurrent diagnostic methods quantitatively.In recent years,we have observed systemic lupus erythematosus(systemic lupus erythematosus,SLE),systemic sclerosis(Systemic Sclerosis,SSc)patients with characteristic microcirculation can show characteristic change,this paper explores the characteristics of microcirculation in SLE,SSc with the characteristic changes in patients with PAH and nailfold microcirculation,ball conjunctival microcirculation,the characteristics of microcirculation and PAH correlation,in order to find early prediction of CTD-related indicators of PAH.Method:1.Selected 228 cases of patients with diagnosis with connective tissue disease(CTD)with and without pulmonary hypertension(PAH).The group included 30 cases of patients with systemic lupus erythematosus with pulmonary hypertension(SLE with PAH group),150 cases of patients without Pulmonary arterial hypertension(SLEwithout PAH group);8 cases of patients with systemic sclerosis with pulmonary hypertension(SSc with PAH group),40 cases of patients without pulmonary hypertension(SSc without PAH group);and 38 cases of healthy group.2.Synchronously recorded the clinical symptoms of the subjects and the laboratory-related autoantibodies: SLE clinical symptoms(serositis,Raynaud’s phenomenon,oral ulcers,hair loss,rash,pleural effusion,pericardial effusion,interstitial pneumonia,lupus nephritis,neuropsychiatric lupus),SSc clinical symptoms(skin ulceration,mouth ulcers,dysphagia,myasthenia muscular weakness,skin tightening,Raynaud’s phenomenon,rash,interstitial pneumonia,pleural effusion,pericardial effusion)and two sets of laboratory-related indicators and autoantibodies,for example,white blood cells(WBC),red blood cell(RBC),erythrocyte sedimentation rate(ESR),complement C3,complement C4,lupus anticoagulant,Anti cardiolipin antibody(ACL),D-dimer,blood uric acid,NT-proBNP,the antinuclear antibodie(ANA),Anti-neutrophil cytoplasmic antibodies(ANCA),anti-SSA antibodies,anti-SSB antibodies and other autoantibodies.3.Observed the nail fold microcirculation,ball conjunctival microcirculation,and microcirculation of SLE-PAH and SSc-PAH patients,and compared the difference with those who without PAH.4.Compared the differences between the two groups of SLE,SSc who with and without PAH in clinical symptoms and laboratory.Results:1.It cloud infer that from nailfold microcirculation integral,the input and output branch diameter,branch diameter,diameter of apical loop loop length,form integral,hydrokinetic integral,integral,total scores patients from SLE-PAH and SSc-PAH groups are higher than without those of patients from PAH group and healthy control group and the differences were statistically significant(P<0.05);it showed that bulbar conjunctiva microcirculation integral,the microvascular number,diameter,fine fine vein artery diameter,uneven thickness,ischemic area,form integral,hydrokinetic integral,integral,total scores of patients from SLE-PAH or SSc-PAH groups were significantly higher than those of patients from non-PAH group and healthy control group and the differences were statistically significant(P<0.05),there was nostatistically significant difference between micro hemangioma and cystic structure project(P>0.05);in the integral of eye signs of microcirculation,hemorrhage,bleeding,old twisted vascular thickening,vascular,reticular malformation,tonal integrals of patients from SLE with PAH or SSc with PAH groups were significantly higher than those of patients from the PAH group and the healthy control group,the differences were statistically significant(P<0.05),and,there was no statistically significant difference between hemangioma and reported injury project integration(P>0.05).2.Raynaud’s phenomenon,pericardial effusion,interstitial pneumonia,blood uric acid and lupus anticoagulant,ACL,D-dimer and the positive rate of NT-pro BNP of patients from SLE with PAH group were higher than that of patients from non-PAH group and the difference was statistically significant(P<0.05).3.The positive rate of pericardial effusion,serum uric acid and lupus anticoagulant,ACL,D-dimer and NT-proBNP of patients from SSc with PAH group were higher than that of patients from non-PAH group and the difference was statistically significant(P >0.05).Conclusion:1.The integral of nailfold microcirculation,bulbar conjunctival microcirculation and eye microcirculation of patients with connective tissue disease associated with pulmonary hypertension were higher than those without pulmonary hypertension,which showed that there was a certain degree of microcirculation abnormality in patients with connective tissue disease associated pulmonary hypertension.Compared with the other two microcirculation tests,the eye microcirculation was more convenient and had certain reference value for the early diagnosis of connective tissue disease associated pulmonary arterial hypertension.2.Raynaud’s phenomenon,pericardial effusion,interstitial pneumonia,blood uric acid and lupus anticoagulant,ACL,D-dimer and positive NT-proBNP may be the risk factors for SLE-PAH.3.Pericardial effusion,elevated serum uric acid,lupus anticoagulant,ACL,Ddimer,and positive NT-proBNP may be the risk factors for SSc-PAH.