| Objective:Raynaud’s phenomenon is a kind of peripheral circulatory disease with the clinical symptoms of acral arteriospasm which is arise by cold and emotional fluctuation, followed by pallor, cynosis and flush, together with pain and paresthesia, and returned to normal because of warmth. According to the etiological factors, the Raynaud’s phenomenon can be classified as Primary Raynaud disease and Secondary Raynaud disease. The Primary Raynaud disease was induced by vasospasm, and there is no potential disease. However, there are always concomitant diseases in Secondary Raynaud disease which always inclined to be called Raynaud’s Syndrome, especially connective tissue diseases such as systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disease. There is still no radicle cure method for the Raynaud’s phenomenon, the symptoms of attack can be alleviated and the attack times can be decreased. The treatment include general treatment, drug treatment and surgical treatment, for the Secondary Raynaud disease, there are always primary disease therapy and getting rid of the injury. The differences of quantitative index of nail-fold microcirculation among the Connective Tissue Disease patients with Raynaud phenomenon, Connective Tissue Disease patients without Raynaud phenomenon and the normal healthy people were studied. Analysis on efficiency of alprostadil in treatments have been studied in this paper with the observation of nail-fold microcirculation.Methods:174cases were chosen and they were divided into three groups:(1) CTD with Raynaud’s phenomenon patients group:20cases of the Secondary Raynaud patients;(2) The CTD without Raynaud’s phenomenon patients group:25cases of connective tissue disease patients without Raynaud’s phenomenon;(3) the healthy control group:29cases are from healthy volunteers.2In this study, the nail-fold microcirculation of the three groups were performed using a system of color microscope and computer analysis, and record the microcirculation of the CTD with Raynaud’s phenomenon patients group after using alprostadil for14days. Synchronization of various clinical and laboratory parameters were observed and recorded, and correlation analysis with laboratory indicators.3Compare the integral values of nail-fold microcirculation of the three groups, and the integral values of nail-fold microcirculation of the first group before and after using the alprostadil.4Statistics work was done with SPSS17.0statistical software.Results:1General Information:(1) the healthy control group:29females, the mean age33.21±10.64years (20～61).(2) CTD without Raynaud’s phenomenon patients group:the25cases are all female with mean age40.20±14.84years (20～67), and the average duration24(67) months (1～204).(3) CTD with Raynaud’s phenomenon patients group:the20cases are all female with mean age38.60±14.55years (21～70), and the average duration12(21) months (1～120). There was no statistical significance in the mean age of the three groups. There was no statistical significance in the average duration of the group CTD without Raynaud’s phenomenon and the group CTD with Raynaud’s phenomenon.2The healthy control group:29females.The healthy people have hairpin shape nail-fold microcirculation images, straight well distributed vessels, and the number of the vessels is normal.There is little giant capillaries, plexiform vascular, avascularization of capillary and irregular-arranged capillary loops except mild abnormal in4cases (13.7%). The nail-fold microcirculation morphology, flow pattern, periloop and total score were0.5(0.5),0.4(0.6),0.0(0.3),1.29±0.58; The CTD patients:45cases. The CTD patients have less capillary loops, more enlarged capillary, more giant capillaries, more severe effusion and more haemorrhages than the healthy people group. The CTD patients without Raynaud’s phenomenon group (25cases):9cases (36%) showed slight abnormality,6cases (24%) moderate abnormality,5cases (20%) severe abnormality, almost normal in5cases (20%).The nail-fold microcirculation morphology, flow pattern, periloop and total score were1.0(3.5),1.7(3.5),0.4(1.2),4.50±2.66; CTD with Raynaud’s phenomenon patients group (20cases):CTD with Raynaud’s phenomenon patients accounted for44.4%of the selected CTD patients. There were2cases (10%) showed slight abnormality,9cases (45%) showed moderate abnormality,9cases (45%) showed severe abnormality and almost normal in5cases (20%). The integral comparison of the three groups:The nail-fold microcirculation total integral of the healthy group was almost normal, the patient with mild abnormal and moderate abnormal nail-fold microcirculation total integral were dominant in number of the CTD patient without RP, the patient with moderate abnormal and severe abnormal nail-fold microcirculation total integral were dominant in number of the CTD patient with RP, the morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation of the CTD patient were higher than that of healthy group, the morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation of the CTD patient with RP were higher than that of the CTD patient without RP. There were significant statistics difference (P<0.05) in the mean score of microcirculation of nail fold, morphologic integral, hydrokinetic integral and the total integral among the three groups.3The comparison between before and after the treatment with alprostadil injection:Before the treatment, there were2cases (10%) with mild abnormal nail-fold microcirculation,9cases were medium abnormal (45%),9cases were severe abnormal (45%); after the treatment, there were9cases (45%) with mild abnormal nail-fold microcirculation,8cases were medium abnormal (40%),2cases were severe abnormal (10%),5cases were almost normal, the number of the medium abnormal and the number of the severe abnormal patient decreased. The comparison of the nail-fold microcirculation integral: Before the treatment the morphological integral was1.4(1.8), flow integral was3.6(4.5), periloop integral was1.2(1.6), and the total integral was7.84±3.86; after the treatment, the morphological integral was0.8(1.0), flow integral was2.9(4.3), periloop integral was0.8(1.2), the total integral was5.32±2.70, the morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation decreased significantly after the treatment. There was significant statistics difference (P<0.05) in the mean score of micro-circulation of nail fold, morphologic integral, hydrokinetic integral and total integral comparison of CTD with Raynaud’s phenomenon between the two groups before and after the treatment using alprostadil.4According to with or without Pulmonary Hypertension, CTD patients were divided into the Pulmonary Hypertension group and the non-Pulmonary Hypertension group. In PAH group, there were9cases, the average age was47.56±15.16years, the nail-fold microcirculation total integral was8.14±5.22; in the non-PAH group, there were25cases, the average age was34.48±12.22years, the nail-fold microcirculation total integral was6.12±2.91, there was no statistical difference between the PAH group and the non-PAH groups (P>0.05); The total integral for the Pulmonary Hypertension group was8.14±5.22, which was much more than the total integral which was6.12±2.91, in the non-Pulmonary Hypertension, there was no statistical difference between the two groups (P>0.05).The total positive rate of URNP was44.4%,4cases were found in the9PAH patients.5According to with or without pulmonary fibrosis, CTD patients were divided into the pulmonary fibrosis group and non-pulmonary fibrosis group. In ILD group, there were10cases, the average age was43.80±13.71years, the nail-fold microcirculation total integral was7.56±5.58; in the non-ILD group, there were21cases, the average age was39.00±15.16years, the nail-fold microcirculation total scores was6.40±2.91, there was no statistical difference between the ILD group and the non-ILD group(P>0.05). The total integral for the ILD group was more than the total integral of the non-ILD group (P>0.05), there was no statistical difference between the two groups.6Analysis of laboratory examination:The nail-fold microcirculation total integral had no correlation with erythrocyte sedimentation rate, C-reactive Protein, C3\C4, IgG and the urine protein but had positive correlation with the increase of age.Conclusions:1The morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation of the CTD patient were higher than that of the healthy group. There was abnormal nail-fold microcirculation in patients with connective tissue disease.2The morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation of the CTD patient with RP were higher than that of the CTD patients without RP, the abnormal degree of nail-fold microcirculation in the CTD patients with RP was severe than the CTD patients without RP.3Using alprostadil injection can improve the nail-fold microcirculation and decrease the morphological integral, flow integral, periloop integral and total integral of nail-fold microcirculation of CTD patients with RP, and there was significant therapeutic action on the Raynaud’s phenomenon induced by connective tissue diseases. |
PDF Full Text Request