背景:甲皱视像下镜检查(NVC)是鉴别诊断雷诺现象(RP)的有价值的工具,存在于某些风湿病(RD)中。知道许多人有心血管危险因素(CVRF),主要目的是证明CVRF和颈动脉斑块会产生NVC改变.
方法:从2020年到2023年进行的横断面单中心研究。形成四组:RD和RP受试者,有RD但没有RP的参与者,有RP的受试者没有RD,最后是没有RP或RD的参与者(研究组)。每位表现出CVRF的受试者仅表现出单个风险因素。收集的变量是:社会人口统计学,CVRF(糖尿病,烟草,酒精(ALC),肥胖(OBE),血脂异常和动脉高血压(AH)),疾病,RP,治疗,弯曲和NVC改变(分支毛细血管,毛细血管扩大,巨大的毛细血管,出血和密度损失)和颈动脉超声(CU)。
结果:包括402名受试者(76%的女性,平均年龄51±16岁),67%有CVRF,50%RP和38%RD。100%的CVRF参与者存在扭曲。发现CVRF的存在与所有NVC改变之间存在统计学上的显着关联:分支毛细血管(OR=95.6),毛细血管增大(OR=59.2),巨大的毛细血管(OR=8.32),出血(OR=17.6)和密度损失(OR=14.4)。特别是,发现巨大毛细血管与AH(p=0.008)和OBE(p〈0.001)之间存在关联,以及ALC和OBE的出血和密度损失(p<0,001)。另一方面,40名受试者出现CU斑块(9.9%),与毛细血管增大相关(OR=8.08),出血(OR=4.04)和分支毛细血管(OR=3.01)。病理性内中膜厚度也与出血有关(OR=3.14)。
结论:CVRF与颈动脉超声动脉粥样硬化和NVC改变之间存在明显关联。这些发现对于正确的NVC解释和避免诊断原发性和继发性RP的假阳性具有特别的意义。
BACKGROUND: Nailfold Videocapillaroscopy (NVC) is a valuable tool in the differential diagnosis of Raynaud\'s phenomenon (RP), present in certain Rheumatic diseases (RD). Knowing that many people have cardiovascular risk factors (CVRF), the main objective was to demonstrate that CVRF and carotid plaques produce NVC alterations.
METHODS: Cross-sectional unicentric study carried out from 2020 to 2023. Four groups were formed: subjects with RD and RP, participants with RD without RP, subjects with RP without RD and finally participants without RP or RD (study group). Each subject exhibiting CVRF presented only a single risk factor. The variables collected were: sociodemographic, CVRF (diabetes, tobacco, alcohol (ALC), obesity (OBE), dyslipidemia and arterial hypertension (AH)), diseases, RP, treatments, tortuosities and NVC alterations (ramified capillaries, enlarged capillaries, giant capillaries, haemorrhages and density loss) and carotid ultrasound (CU).
RESULTS: 402 subjects were included (76 % women, mean age 51 ± 16 years), 67 % had CVRF, 50 % RP and 38 % RD. Tortuosities were present in 100 % of CVRF participants. A statistically significant association was found between the presence of CVRF and all the NVC alterations: ramified capillaries (OR = 95.6), enlarged capillaries (OR = 59.2), giant capillaries (OR = 8.32), haemorrhages (OR = 17.6) and density loss (OR = 14.4). In particular, an association was found between giant capillaries with AH (p = 0,008) and OBE (p 〈0,001), and haemorrhages and density loss with ALC and OBE (p < 0,001). On the other hand, 40 subjects presented CU plaques (9.9 %), associated with enlarged capillaries (OR = 8.08), haemorrhages (OR = 4.04) and ramified capillaries (OR = 3.01). The pathological intima-media thickness was also associated with haemorrhages (OR = 3.14).
CONCLUSIONS: There is a clear association between CVRF and ultrasound atherosclerotic findings in carotid with NVC alterations. These findings are of special interest for a correct NVC interpretation and to avoid false positives in the diagnosis of primary and secondary RP.