微循环的改变在系统性红斑狼疮中的临床意义

发布时间：2018-02-11 17:14

本文关键词： 系统性红斑狼疮甲襞微循环目征球结膜微循环半定量积分相关性　出处：《南昌大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景目的:系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种慢性、免疫介导性、炎性多系统疾病,本病可累及血管,引起多器官多系统性病变,血管的损害是SLE本身的一种表现。SLE血管损害主要由免疫复合物在血管壁沉积介导引发一系列补体级联活化反应引起,该病病理基础为血管炎。甲襞微循环(NCV)检查作为一种无创性的微血管检查方法在国际上已越来越广泛地用于系统性硬化症患者的微血管病变评估、病情监测和疗效评估。该项技术在系统性红斑狼疮患者中的应用研究已取得了一定进展,然而,关于系统性红斑狼疮患者受累脏器不同及不同疾病状态时与微循环之间的关系研究,国内报道较少,国外研究也处于刚刚起步阶段,研究相对较少且没有一致的结论。血瘀证目征是一种客观,准确的判断血瘀证轻重程度的方法。由李国贤教授最先提出的一种定量诊断血瘀证的新体征。是通过观察球结膜微循环的血管改变、报伤点、血管瘤、网状畸形及眼周皮肤等指标判断血瘀证轻重程度。而目征球结膜微循环积分是在血瘀证目征基础上参照田牛氏球结膜微循环综合定量评价方法得出的一种观察球结膜微循环的方法。本实验探究目的总共分为三部分。第一部分为观察SLE患者微循环改变特征。第二部分为探讨SLE患者的临床症状,自身抗体与甲襞微循环,目征球结膜微循环改变之间的关系。第三部分为探究SLE患者的甲襞微循环积分,目征球结膜微循环积分与血白细胞(WBC)、血小板(PLT)、补体C3、补体C4、24小时尿蛋白定量、疾病活动度(SLEDAI)、血沉之间的相关性,探究微循环检查是否对SLE的实验室检查及病情程度有所提示作用。方法:选取我科确诊为SLE的患者80例,健康志愿者20例。分别比较两组间的微循环差异。再将SLE 80例患者分别根据有无肺间质纤维化(ILD),将SLE患者分为ILD组和无ILD组、根据有无肺动脉高压(PAH),将SLE患者分为PAH组和无PAH组;按有无皮疹分为SLE皮疹组和SLE无皮疹组;按有无雷诺现象(RP)分为RP组和无RP组,根据各抗体存在情况分为阳性组和阴性组两组,比较两组间甲襞微循环、目征球结膜微循环的差异。分析目征球结膜微循环积分、甲襞微循环半定量积分与SLEDAI、24小时尿蛋白定量、补体C3、补体C4、血沉(ESR)、血白细胞(WBC)、血小板(PLT)之间的相关性。结果:1.本研究甲襞微循环积分在毛细血管分支、毛细血管数量、扩大毛细血管、巨大毛细血管、微出血、毛细血管排列失规则项目积分中,SLE组积分高于HC组,差异有统计学意义(P0.05);目征球结膜微循环积分在新鲜出血、陈旧出血、扭曲血管、增粗血管、网状畸形、血管瘤、色调积分项目中,SLE组积分高于HC组,差异有统计学意义(P0.05),而在报伤点积分中SLE组高于HC组,但无统计学意义(P0.05)。2.在SLE组内甲襞微循环积分中,根据各临床症状有无,各抗体阳性与否分组中;在有皮疹组中毛细血管数量积分大于无皮疹组,差异有统计学意义(P0.05)。在有雷诺现象组中毛细血管分支、毛细血管数量积分大于无雷诺现象组,在有间质性肺病组巨大毛细血管、毛细血管排列失规则积分大于无间质性肺病组,在有肺动脉高压组毛细血管分支、扩大毛细血管积分大于无肺动脉高压组,在抗RNP抗体阳性组扩大毛细血管积分大于抗RNP抗体阴性组,差异均有统计学意义(P0.05)。而在抗SS-A抗体阳性组,抗DS-DNA抗体阳性组与阴性组比较,差异无统计学意义。在SLE组内目征球结膜微循环总积分中,根据各临床症状有无,各抗体阳性与否分组中;在有雷诺现象组,有肺动脉高压组,抗RNP抗体阳性组中总积分大于无症状或抗体阴性组,差异有统计学意义(P0.05)。而在有皮疹组,间质性肺病组,抗DS-DNA抗体阳性组,抗SS-A抗体阳性组球结膜微循环总积分大于阴性组,但差异无统计学意义(P0.05)。3.在SLE组中甲襞微循环,目征球结膜微循环积分与血白细胞(WBC)、血小板(PLT)、补体C3、补体C4、疾病活动度(SLEDAI)、24小时尿蛋白定量、血沉(ESR)等相关性研究中,相互之间无相关性(P0.05)。结论:系统性红斑狼疮患者的甲襞微循环,目征球结膜微循环积分高于健康者,说明系统性红斑狼疮患者存在微循环障碍。在系统性红斑狼疮患者中,甲襞微循环检查项目与有否皮疹、间质性肺病、肺动脉高压、抗RNP抗体有关;甲襞微循环检查中的各具体项目积分可提示相应各临床症状。目征球结膜微循环检查指标与有否雷诺现象,肺动脉高压,抗RNP抗体有关。目征球结膜微循环检查中各具体项目可提示相应的临床症状及抗体阳性与否。微循环检查可对SLE患者的一些临床症状及受累脏器有一定的预测作用。
[Abstract]:Background and objective: systemic lupus erythematosus (systemic lupus, erythematosus, SLE) is a chronic, immune-mediated inflammatory, multisystem disease, this disease can affect blood vessels, causing multiple organ lesions, vascular damage is a kind of expression of.SLE and vascular damage of SLE itself is mainly composed of immune complexes in the blood vessels wall deposition mediated triggered a series of reactions caused by activation of the complement cascade, the pathological basis for vasculitis. The nailfold microcirculation (NCV) as a noninvasive method of micro vascular examination in the world has been more and more widely used in microvascular system of evaluating scleredema patients, assessment of disease monitoring and treatment the application of this technique. In patients with systemic lupus erythematosus has made some progress, however, the research on the relationship between the patients with systemic lupus erythematosus and different organs involved in various disease states and microcirculation in between, Domestic and foreign research reports, also at the initial stage, the research is relatively less and there is no consistent conclusion. Eye signs of blood stasis syndrome is a kind of objective, the judgment method of blood stasis syndrome severity accurately. A new quantitative diagnosis of blood stasis syndrome was first proposed by Professor Li Guoxian. By observing the change of microcirculation of bulbar conjunctiva the blood vessels, trauma, hemangioma, reticular malformation and eye skin index to judge the severity of blood stasis syndrome and bulbar conjunctiva microcirculation. The integral is a method of observation of bulbar conjunctival microcirculation based on blood stasis syndrome based on comprehensive quantitative eye conjunctiva microcirculation Tian Niu's ball evaluation methods obtained. The aim of research this experiment is divided into three parts. The first part is to observe the changes of microcirculation in patients with SLE. The second part is to investigate the clinical symptoms of patients with SLE, autoantibodies and Nailfold Microcirculation of bulbar conjunctiva microcirculation, eye syndrome The relationship between the changes of rings. The third part is to explore the Nailfold Microcirculation of patients with SLE syndrome integral, eye conjunctival microcirculation integral and white blood cell (WBC), platelet (PLT), complement C3, complement C4,24 proteinuria, disease activity (SLEDAI), the correlation between erythrocyte sedimentation rate, explore the microcirculation examination if the SLE inspection and laboratory condition extent indication. Methods: selected in our department diagnosed 80 cases of SLE patients, 20 healthy volunteers respectively. Microcirculation were compared between the two groups. The 80 cases of SLE patients respectively according to the presence or absence of pulmonary interstitial fibrosis (ILD), SLE patients were divided into ILD group and non ILD group according to the presence or absence of pulmonary arterial hypertension (PAH), SLE patients were divided into PAH group and non PAH group; according to whether the rash is divided into SLE group and SLE group without rash rash; according to whether the phenomenon of Reynolds (RP) were divided into RP group and non RP group according to the presence of antibody were divided into positive group and negative Of the two groups were compared between the two groups of nailfold microcirculation, difference of eye signs of bulbar conjunctival microcirculation. Analysis of eye signs of bulbar conjunctival microcirculation of Nailfold Microcirculation of semi quantitative integral, integral and SLEDAI, 24 hour urinary protein, complement C3, complement C4, erythrocyte sedimentation rate (ESR), white blood cell (WBC), platelet (the correlation between PLT). Results: 1. the study of Nailfold Microcirculation in integral capillary branches, the number of capillaries, expand capillaries, huge capillaries, micro capillary hemorrhage, loss of arrangement rule of project integration, integration of group SLE is higher than that of HC group, the difference was statistically significant (P0.05); eye signs of bulbar conjunctival microcirculation integral in fresh blood old hemorrhage, twisted blood vessels, dilated blood vessels, reticular malformation, hemangioma, color integration project, SLE group score higher than HC group, the difference was statistically significant (P0.05), while in the SLE group than in HC group reported injury points, but no statistical significance (P0.05) in.2. In the SLE group of Nailfold Microcirculation integration, according to the clinical symptom, the antibody positive and negative group; in the number of capillaries rash group points greater than no rash group, the difference was statistically significant (P0.05). In the group with RP capillary, capillary number is greater than the integral without Raynaud's phenomenon in the group. Interstitial lung disease group huge capillary, capillary loss rule arrangement points greater than without interstitial lung disease group in pulmonary hypertension group, capillary branches, expand capillary integral is larger than the group without pulmonary hypertension, expand capillary integral is larger than the anti RNP antibody negative group in anti RNP antibody positive group, the differences were statistically significant (P0.05). In the anti SS-A antibody positive group and anti DS-DNA antibody positive group and negative group, the difference was not statistically significant. In the SLE group within the eye signs of bulbar conjunctival microcirculation in the total score, according to the clinical There are no symptoms, the antibody positive and negative group; in RP group, pulmonary hypertension group, the total score of anti RNP antibody positive group than those without symptoms or antibody negative group, the difference was statistically significant (P0.05). While in the group of rash, interstitial lung disease group, anti DS-DNA antibody positive group, anti SS-A antibody positive group is greater than the total score of bulbar conjunctival microcirculation negative group, but the difference was not statistically significant (P0.05.3.) in the SLE group of Nailfold Microcirculation of bulbar conjunctiva microcirculation, eye syndrome integral and white blood cell (WBC), platelet (PLT), complement C3, complement C4, disease activity (SLEDAI), 24 hour urinary protein, erythrocyte sedimentation rate (ESR) and other related studies, no correlation between (P0.05). Conclusion: the Nailfold Microcirculation in patients with systemic lupus erythematosus, eye signs of bulbar conjunctival microcirculation score higher than that of healthy subjects, indicating systemic lupus erythematosus patients in systemic microcirculation. Lupus, nailfold microcirculation examination project and whether there is a rash, interstitial lung disease, pulmonary hypertension, anti RNP antibody; the specific project of Nailfold Microcirculation examination points may suggest corresponding clinical symptoms. Eye signs of bulbar conjunctival microcirculation indexes and have Raynaud, pulmonary hypertension, anti RNP antibody. The specific project sign of Bulbar Conjunctival Microcirculation may be suggested to check the corresponding clinical symptoms and antibody positive or not. Microcirculation examination can have certain prediction function on some of the clinical symptoms and organ involvement in SLE patients.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R593.241

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