■对于初级雷诺现象(PRP),假定了无法解释的血管痉挛倾向。为了检验独特的超微结构微血管改变的额外参与的假设,我们比较了PRP患者和健康对照者的甲皱毛细血管模式.
■将120例PRP患者(血管痉挛症状的中位持续时间为60[IQR:3-120]个月)与125例对照进行了比较。在这两组中,进行甲褶毛细管镜检查以记录扩张的存在,毛细血管水肿,曲折的毛细血管,分支,出血,并降低毛细血管密度,并确定半定量评分。Further,通过红外热成像结合冷激发来研究手指皮肤复温的能力。
■在两者中均发现了非特异性形态学改变,PRP,如控件,在毛细血管扩张的情况下,PRP的风险是毛细血管扩张的四倍(CI:2.3-7.6),如果毛细血管密度降低,则是其五倍(CI:1.9-13.5)。PRP组的毛细血管密度与双手的体温调节能力相关,但不是在控制中。此外,仅PRP患者的微血管病变评分与双手复温百分比之间呈负相关.
■我们发现PRP患者和对照组之间的微血管结构存在特定差异。作为结论,PRP可能不是完全良性的血管痉挛现象,但可能与细微的微循环血管病变有关。此外,我们建议,评分系统的实施至少可以作为长期PRP患者诊断过程的指导.
For primary Raynaud phenomenon (PRP), an otherwise unexplained vasospastic disposition is assumed. To test the hypothesis of an additional involvement of distinct ultrastructural microvascular alterations, we compared the nailfold capillary pattern of patients with PRP and healthy controls.
A total of 120 patients with PRP (with a median duration of vasospastic symptoms of 60 [IQR: 3-120] months) were compared against 125 controls. In both groups, nailfold capillaroscopy was performed to record the presence of dilatations, capillary edema, tortuous capillaries, ramifications, hemorrhages, and reduced capillary density and to determine a semiquantitative rating score. Further, the capacity of finger skin rewarming was investigated by performing infrared thermography in combination with cold provocation.
Unspecific morphologic alterations were found in both, PRP, such as controls, whereby the risk for PRP was four times as high in the presence of capillary dilations (CI: 2.3-7.6) and five times as high if capillary density was reduced (CI: 1.9-13.5). Capillary density correlated with thermoregulatory capacity in both hands in the PRP group, but not in controls. In addition, a negative correlation between the microangiopathy score and the percentage degree of rewarming in both hands was found for patients with PRP only.
We found specific differences within the microvascular architecture between patients with PRP and controls. As a conclusion, PRP may not be an entirely benign vasospastic phenomenon, but might be associated with subtle microcirculatory vasculopathy. In addition, we suggest that the implementation of a scoring system might serve as guidance in the diagnostic process at least of patients with long-standing PRP.