A PROSPECTIVE-STUDY OF RAYNAUD PHENOMENON AND EARLY CONNECTIVE-TISSUE DISEASE - A 5-YEAR REPORT
A PROSPECTIVE-STUDY OF RAYNAUD PHENOMENON AND EARLY CONNECTIVE-TISSUE DISEASE - A 5-YEAR REPORT
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DOI：
10.1016/0002-9343(82)90846-4
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发表时间：
1982-01-01
影响因子：
5.9
通讯作者：
LEROY, EC
中科院分区：
文献类型：
--
作者：
HARPER, FE;MARICQ, HR;LEROY, EC
为了确定雷诺现象患者的特征，预测结缔组织疾病的发展，我们开展了一项前瞻性研究。有雷诺现象病史或身体证据而无病因或相关疾病的患者进行初始多系统评估。持续时间少于5年的硬皮病（系统性硬化症）被纳入比较。患者分为雷诺现象、未分化结缔组织综合征或硬皮病。甲襞毛细血管显微镜检查，从编码照片中盲目评分。91例入组患者中（仅雷诺现象49例，未分化结缔组织综合征22例，硬皮病20例），49例中有7例出现硬皮病型毛细血管异常，22例中有19例，20例中有19例（P < 0.005）。在39例雷诺现象患者中（平均持续时间23.7个月），3例出现未分化结缔组织综合征。在随访的17例未分化结缔组织综合征患者中（平均持续时间27.6个月），6例患者发生过渡(4例硬皮病，1例硬皮病-系统性红斑狼疮（SLE）重叠；一个系统性红斑狼疮)。甲襞毛细血管异常对两组过渡性患者最敏感（9人中有8人），比ANA[抗核抗体]（9人中有6人）、指端溃疡（9人中有4人）或食管运动减少（9人中有2人）更敏感。这项前瞻性研究证明了毛细管检查在评估雷诺现象中的有用作用。毛细血管异常表明结缔组织疾病的风险增加；正常毛细血管有利于特发性雷诺现象。
To define features of patients with Raynaud phenomenon that predict the evolution of connective tissue disorders, a prospective study was initiated. Patients with a history or physical evidence of Raynaud phenomenon without causal or associated disorders underwent initial multisystem evaluation. Scleroderma (systemic sclerosis) of less than 5 yr duration was included for comparison. Patients were classified as having Raynaud phenomenon only, undifferentiated connective tissue syndrome or scleroderma. Nailfold capillary microscopy was performed, and patterns were scored blindly from coded photographs. Of 91 patients with Raynaud phenomenon entered (Raynaud phenomenon only, n = 49; undifferentiated connective tissue syndrome, n = 22; scleroderma, n = 20), abnormal scleroderma pattern capillaries were noted in 7 of 49, 19 of 22 and 19 of 20, respectively (P < 0.005). Of 39 patients with Raynaud phenomenon only followed (mean duration, 23.7 mo.) undifferentiated connective tissue syndrome developed in 3. Of 17 patients with undifferentiated connective tissue syndrome followed (mean duration, 27.6 mo.), 6 patients had transitions (4 scleroderma; 1 scleroderma-systemic lupus erythematosus (SLE) overlap; one SLE). Nailfold capillary abnormalities best identified transitional patients in both groups (8 of 9) and were more sensitive than ANA [antinuclear antibodies] (6 of 9), presence of digital ulcers (4 of 9) or decreased esophageal motility (2 of 9). This prospective study documents a useful role for capillary examinations in evaluating Raynaud phenomenon. Abnormal capillaries indicate an increased risk for connective tissue disease; normal capillaries favor idiopathic Raynaud phenomenon.