| Objective: Systemic lupus erythematosus (SLE) is a kind of diffuseconnective tissue disease, involving multiple systems, the cause is not veryclear. The disease can produce a variety of autoantibodies, thus lead to theactivation of the complement cascade a series of reactions, leading to organdamage. Nailfold capillaroscopy(NC) is a noninvasive, easy-to-preform,repeatabily, economical, and objective technique. Initially, scholars throughcomparative study found differences in nail fold microcirculation in subjectsbetween the connective tissue disease and the healthy, and found the diversityof the capillaroscopic abnormalities. The application of this technique inpatients with systemic lupus erythematosus has also made some progresses.However, it is still in its infancy stage without agreement in foreign researcheswhat capillaroscopic abnormalities differences between the active and stablestage of SLE, and whether NC abnormalities were associated with organdamages, while it is rarely reported in domestic studies. This study aims tocontrast and summarize microcirculation features of SLE patients, in order todifferentiate the active from the stable of SLE patients, and identifycorrelations with different organ involvement, and examine whether NC ishelpful to the early diagnosis of SLE.Methods:1Select41SLE patients as the SLE group; while choosing33cases ofhealthy volunteers as a control group. Check and record microcirculationabnormalities scores.2All cases were selected for NC. To contrast between the SLE andcontrol groups, simultaneously record of Systemic Lupus ErythematosusDisease Activity Index(SLEDIA), the autoantibodies, the WBC and PLT, theurine protein, the complement(C3/C4), the erythrocyte sedimentation rate (ESR), whether interstitial lung disease(ILD), whether pulmonary arteryhypertension(PAH) and rash, Raynaud’s phenomenon(RP).3The case group is divided based on the Raynaud’s phenomenon,interstitial lung disease, and according to the autoantibodies. Record the countof WBC, PLT, proteinuria, complement (C3/C4), ESR, and SLEDAI scores,and then analyze the associations.4Statistics work was done with SPSS16.0statistical software.Results:1General Information:(1) the control group:33females, the mean age34.06±10.98years.(2) the SLE group:41females, the mean age34.54±13.89years. To compare ages of the SLE group and control one: P>0.05, thedifference was not statistically significant.(3) SLE with ILD patients group:10females, mean age36.4±14.75years. SLE without ILD patients group:31females, mean age33.94±13.80years. Comparison of ages from two groups:P>0.05, no significantly difference.(4) SLE with PAH patients group:6females, mean age31.50±16.80years. SLE without PAH patients group:35females, mean age35.06±13.55years. Comparison of ages from two groups:P>0.05, no significantly difference.(5) SLE with rash patients group:25females, mean age35.08±13.20years. SLE without rash patients group:16females, mean age33.69±15.32years. Comparison of ages from two groups:P>0.05, no significantly difference.(6) SLE with RP patients group:15females, mean age34.20±8.87years. SLE without RP patients group:26females, mean age34.73±16.27years. Comparison of ages from two groups:P>0.05, no significantly difference.(7) the antinuclear antibodies(ANA):Homogeneous type group:27females, mean age36.19±14.66years. Nuclearpoint type group:1females, age28years. Speckled type group:13females,mean age31.93±12.83years. Comparison of ages from groups homogeneoustype and speckled type: P>0.05, no significantly difference.(8) SLE withpositive anti-dsDNA antibody patients group:25females, mean age35.68±13.65years. SLE with negative anti-dsDNA antibody patients group:16females, mean age32.75±14.53years. Comparison of ages from two groups: P>0.05, no significantly difference.(9) SLE with positive anti-SSA antibodypatients group:21females, mean age34.90±11.24years. SLE with negativeanti-SSA antibody patients group:20females, mean age34.15±16.53years.(10) SLE with positive anti-RNP antibody patients group:18females, meanage33.94±12.77years. SLE with negative anti-RNP antibody patients group:23females, mean age34.83±15.14years. Comparison of ages from twogroups: P>0.05, no significantly difference.(11)Compared to the above agesof every two groups, P>0.05, comparable.2Comparison the nail-fold microcirculation scores between the SLEpatients group and the control. The NC total score, periloop, flow pattern, andmorphology score,2.50±1.40,0.82±0.96,0.94±1.02,0.74±0.46, werelower than those of SLE patients group,9.04±3.83,4.07±6.64,3.22±2.14,2.73±2.48, P <0.01.3According to the presence or absence of pulmonary fibrosis in the SLEpatients were divided into groups: with and without ILD. ILD group:10cases,microcirculation total score was9.34±3.92; non-ILD group:31patients,microcirculation total score was8.12±3.58. The P values were all greaterthan0.05, the difference was not statistically significant.4According to the presence or absence of pulmonary hypertension, theSLE patients were divided into groups with and without PAH. PAH group:6cases, microcirculation total points9.43±3.81; non-PAH group:35patients,the microcirculation total score was8.97±3.89. The nonparametric test tocompare age of2groups showed P>0.05, namely no significantly difference;The rank test to compare microcirculation total score between the twoindependent samples of nail fold,showed the value of P>0.05, there was nostatistically significant.5Divided according to the rash associated with SLE. SLE with rashgroup:25patients, microcirculation total score was9.87±3.90; SLE withoutrash ones:16patients, the NC total score was7.74±11.79. The P to comparenonparametric test of age was>0.05, the difference was not statisticallysignificant. Compared two independent samples of nail fold microcirculation flow pattern points, periloop scores, P>0.05, the difference was notstatistically significant; The NC morphology in group with rash was higherthan that in group without rash, respectively3.33±2.87and1.79±1.28, P<0.05.6Divided according to raynaud’s phenomenon(RP) into the RP groupand non-RP group. RP group:15patients. Microcirculation total score was10.07±4.25; non-RP group:26patients. Microcirculation total score was8.45±3.51. The P values of T-test was greater than0.05comparing the two groupsof age, no significantly difference. To compare the NC total, periloop andmorphology scores of the two groups, showed P>0.05, the difference was notstatistically significant; points of the flow pattern of the group with RP washigher than that of the group without RP(respectively4.05±2.71and2.73±1.59, P <0.05.7In41patients of SLE patient group, the antinuclear antibodies(ANA)were positive, which accounted for68.85%of homogeneous type, NC totalscore was7.90±2.94. And1case was nuclear point type ANA, the NC totalscore was6.80. The speckled type ANA accounted for31.71%, the NC totalscore was11.58±4.45. And the total scores of the homogeneous type groupwas higher than that of the speckled type ones, P<0.05. Comparison betweenthe groups’ NC flow pattern, morphology score, the P values were greater than0.05, the difference was not statistically significant. The NC periloop score ofspeckled type(3.73±2.48) was higher than that of the homogeneous typegroup(2.76±1.36), P<0.05.8Divided by anti-ds-DNA into anti-ds-DNA positive and negative groups.Anti-ds-DNA positive group:25patients. Microcirculation total score was8.33±2.85; anti-ds-DNA negative group:16patients, with microcirculationtotal points of10.14±4.89. To compare the microcirculation total points andperiloop points, the P>0.05, the difference was not statistically significant.The morphology score in groups with anti ds-DNA positive was lower thanthat in the negative one, respectively1.97±1.36and3.93±3.30, P <0.05.9Divided by anti-RNP antibodies into anti-RNP antibody positive and negative ones. Anti-RNP antibody positive group:18patients. Capillary totalscore was10.31±4.56; anti-RNP negative group:23patients.Microcirculation total scored8.05±2.88. Two Microcirculation total score,periloop integrals and flow state points of2groups were similarity, and P wasgreater than0.05, no statistical difference. Morphology scores of the anti-RNP antibody positive was higher than that of the negative one, respectively3.55±3.25and2.09±1.41, P <0.05.10Divided groups by anti-SSA antibody into positive and negative ones.Anti-SSA antibody-positive group:21patients. Microcirculation total scorewas9.70±3.92; anti-SSA-negative group:20patients, with a total score ofmicrocirculation8.34±3.70. Non-parametric test P>0.05comparing the twogroups of age, no significantly difference. The scores of microcirculation total,morphology, flow pattern were compared, and the result was P>0.05, thedifference was not statistically significant. The periloop score of anti-SSAantibody in positive group was higher than that of the negative one,respectively5.69±8.97and2.38±1.48, P <0.05.11Correlation analysis: compare the microcirculation total scores,morphological integration, flow pattern points, periloop integrals of SLEDAI,Proteinuria, complement C3, C4, ESR, WBC, PLT, and the results showed nosignificant correlation.Conclusions:1the NC scores of patients with systemic lupus erythematosus, includingtotal scores, morphology scores, flow pattern points, and periloop integralswere higher than that of healthy control ones, and patients with SLE indeedsuffer from microcirculation abnormalities.2Raynaud’s phenomenon in patients with systemic lupus erythematosusmay be caused by the damage of microcirculation blood flow.3ANA particle type and anti-SSA antibodies in SLE patients may beassociated with changes in microvascular function (periloop injury).4The rash, anti-ds-DNA antibodies and anti-RNP antibodies in SLEpatients may be associated with changes in the microcirculation vascular morphology.5Capillaroscopic examination may have some reference value indiagnosis of systemic lupus erythematosus. |
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