背景:麻风病,慢性传染病,与各种指甲变化有关。它的病因是多方面的,微血管损伤至关重要。指甲折叠毛细管镜检查(NFC)是检测麻风病早期血管缺陷的新工具。该研究旨在评估和提供麻风病患者NFC变化的完整临床特征。
方法:这是一项观察性横断面研究,在三级医院进行了1.5年(2021年1月至2022年8月),包括60名诊断为麻风病的患者(18-60岁)。在获得知情同意后;详细的历史,进行了完整的皮肤和神经系统检查。检查所有手指甲和脚趾甲的临床变化。随后,使用USB类型的视频皮肤镜(型号AM7115MZTDino-lite)进行甲癣镜检查,一种非侵入性工具。接下来是NFC,对所有指甲进行操作,图像由单个操作员记录,然后评估定量和定性变化,并使用SPSSv20进行统计分析,使用Studentt检验比较平均毛细血管密度,按比例评估的形态变化频率,以及使用卡方或费舍尔精确检验进行的分组比较,显著性阈值为p<0.05。
结果:在60名患者中,39人属于麻木病组,其中包括边缘麻风病(BL)和麻风病(LL)患者,17人属于结核杆菌组,其中包括临界结核样(BT)麻风病人;23.3%有1型反应,18.3%有2型反应。甲褶毛细管镜检查(NFC)在93.3%的患者中显示微血管变化。平均毛细管密度为6.8±1.5毛细管/mm,与结核样组(7.0±0.86)相比,麻生组的密度较低(6.5±1.09)。结核样组中最常见的NFC变化是曲折的毛细血管(70%),毛细血管脱落,毛细血管扩张(均为64.7%)。在麻木病组,毛细血管脱落(82%)最常见,其次是曲折(69%),后退(69%),和扩张的毛细血管(66%)。在麻生病组中,扩张且突出的乳头下丛更为常见(35%,p=0.04)。麻发菌组营养改变的患者有更多的毛细血管脱落和奇异的毛细血管。毛细血管脱落,扩张的毛细血管,可见的乳头状下静脉丛在2型反应患者中更为普遍。
结论:NFC改变在结核性和麻风病中都很普遍,这可能是外周血管受损和营养变化的指标,尤其是麻风病.NFC可以作为检测麻风病患者微血管异常的辅助工具。
Leprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients.
It is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18-60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student\'s t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05.
Among the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed
microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions.
NFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.