本文關(guān)鍵詞： 系統(tǒng)性紅斑狼瘡 甲襞微循環(huán) 目征球結(jié)膜微循環(huán) 半定量積分 相關(guān)性　出處：《南昌大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景目的:系統(tǒng)性紅斑狼瘡(systemic lupus erythematosus,SLE)是一種慢性、免疫介導(dǎo)性、炎性多系統(tǒng)疾病,本病可累及血管,引起多器官多系統(tǒng)性病變,血管的損害是SLE本身的一種表現(xiàn)。SLE血管損害主要由免疫復(fù)合物在血管壁沉積介導(dǎo)引發(fā)一系列補(bǔ)體級(jí)聯(lián)活化反應(yīng)引起,該病病理基礎(chǔ)為血管炎。甲襞微循環(huán)(NCV)檢查作為一種無創(chuàng)性的微血管檢查方法在國(guó)際上已越來越廣泛地用于系統(tǒng)性硬化癥患者的微血管病變?cè)u(píng)估、病情監(jiān)測(cè)和療效評(píng)估。該項(xiàng)技術(shù)在系統(tǒng)性紅斑狼瘡患者中的應(yīng)用研究已取得了一定進(jìn)展,然而,關(guān)于系統(tǒng)性紅斑狼瘡患者受累臟器不同及不同疾病狀態(tài)時(shí)與微循環(huán)之間的關(guān)系研究,國(guó)內(nèi)報(bào)道較少,國(guó)外研究也處于剛剛起步階段,研究相對(duì)較少且沒有一致的結(jié)論。血瘀證目征是一種客觀,準(zhǔn)確的判斷血瘀證輕重程度的方法。由李國(guó)賢教授最先提出的一種定量診斷血瘀證的新體征。是通過觀察球結(jié)膜微循環(huán)的血管改變、報(bào)傷點(diǎn)、血管瘤、網(wǎng)狀畸形及眼周皮膚等指標(biāo)判斷血瘀證輕重程度。而目征球結(jié)膜微循環(huán)積分是在血瘀證目征基礎(chǔ)上參照田牛氏球結(jié)膜微循環(huán)綜合定量評(píng)價(jià)方法得出的一種觀察球結(jié)膜微循環(huán)的方法。本實(shí)驗(yàn)探究目的總共分為三部分。第一部分為觀察SLE患者微循環(huán)改變特征。第二部分為探討SLE患者的臨床癥狀,自身抗體與甲襞微循環(huán),目征球結(jié)膜微循環(huán)改變之間的關(guān)系。第三部分為探究SLE患者的甲襞微循環(huán)積分,目征球結(jié)膜微循環(huán)積分與血白細(xì)胞(WBC)、血小板(PLT)、補(bǔ)體C3、補(bǔ)體C4、24小時(shí)尿蛋白定量、疾病活動(dòng)度(SLEDAI)、血沉之間的相關(guān)性,探究微循環(huán)檢查是否對(duì)SLE的實(shí)驗(yàn)室檢查及病情程度有所提示作用。方法:選取我科確診為SLE的患者80例,健康志愿者20例。分別比較兩組間的微循環(huán)差異。再將SLE 80例患者分別根據(jù)有無肺間質(zhì)纖維化(ILD),將SLE患者分為ILD組和無ILD組、根據(jù)有無肺動(dòng)脈高壓(PAH),將SLE患者分為PAH組和無PAH組;按有無皮疹分為SLE皮疹組和SLE無皮疹組;按有無雷諾現(xiàn)象(RP)分為RP組和無RP組,根據(jù)各抗體存在情況分為陽(yáng)性組和陰性組兩組,比較兩組間甲襞微循環(huán)、目征球結(jié)膜微循環(huán)的差異。分析目征球結(jié)膜微循環(huán)積分、甲襞微循環(huán)半定量積分與SLEDAI、24小時(shí)尿蛋白定量、補(bǔ)體C3、補(bǔ)體C4、血沉(ESR)、血白細(xì)胞(WBC)、血小板(PLT)之間的相關(guān)性。結(jié)果:1.本研究甲襞微循環(huán)積分在毛細(xì)血管分支、毛細(xì)血管數(shù)量、擴(kuò)大毛細(xì)血管、巨大毛細(xì)血管、微出血、毛細(xì)血管排列失規(guī)則項(xiàng)目積分中,SLE組積分高于HC組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);目征球結(jié)膜微循環(huán)積分在新鮮出血、陳舊出血、扭曲血管、增粗血管、網(wǎng)狀畸形、血管瘤、色調(diào)積分項(xiàng)目中,SLE組積分高于HC組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而在報(bào)傷點(diǎn)積分中SLE組高于HC組,但無統(tǒng)計(jì)學(xué)意義(P0.05)。2.在SLE組內(nèi)甲襞微循環(huán)積分中,根據(jù)各臨床癥狀有無,各抗體陽(yáng)性與否分組中;在有皮疹組中毛細(xì)血管數(shù)量積分大于無皮疹組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在有雷諾現(xiàn)象組中毛細(xì)血管分支、毛細(xì)血管數(shù)量積分大于無雷諾現(xiàn)象組,在有間質(zhì)性肺病組巨大毛細(xì)血管、毛細(xì)血管排列失規(guī)則積分大于無間質(zhì)性肺病組,在有肺動(dòng)脈高壓組毛細(xì)血管分支、擴(kuò)大毛細(xì)血管積分大于無肺動(dòng)脈高壓組,在抗RNP抗體陽(yáng)性組擴(kuò)大毛細(xì)血管積分大于抗RNP抗體陰性組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。而在抗SS-A抗體陽(yáng)性組,抗DS-DNA抗體陽(yáng)性組與陰性組比較,差異無統(tǒng)計(jì)學(xué)意義。在SLE組內(nèi)目征球結(jié)膜微循環(huán)總積分中,根據(jù)各臨床癥狀有無,各抗體陽(yáng)性與否分組中;在有雷諾現(xiàn)象組,有肺動(dòng)脈高壓組,抗RNP抗體陽(yáng)性組中總積分大于無癥狀或抗體陰性組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而在有皮疹組,間質(zhì)性肺病組,抗DS-DNA抗體陽(yáng)性組,抗SS-A抗體陽(yáng)性組球結(jié)膜微循環(huán)總積分大于陰性組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.在SLE組中甲襞微循環(huán),目征球結(jié)膜微循環(huán)積分與血白細(xì)胞(WBC)、血小板(PLT)、補(bǔ)體C3、補(bǔ)體C4、疾病活動(dòng)度(SLEDAI)、24小時(shí)尿蛋白定量、血沉(ESR)等相關(guān)性研究中,相互之間無相關(guān)性(P0.05)。結(jié)論:系統(tǒng)性紅斑狼瘡患者的甲襞微循環(huán),目征球結(jié)膜微循環(huán)積分高于健康者,說明系統(tǒng)性紅斑狼瘡患者存在微循環(huán)障礙。在系統(tǒng)性紅斑狼瘡患者中,甲襞微循環(huán)檢查項(xiàng)目與有否皮疹、間質(zhì)性肺病、肺動(dòng)脈高壓、抗RNP抗體有關(guān);甲襞微循環(huán)檢查中的各具體項(xiàng)目積分可提示相應(yīng)各臨床癥狀。目征球結(jié)膜微循環(huán)檢查指標(biāo)與有否雷諾現(xiàn)象,肺動(dòng)脈高壓,抗RNP抗體有關(guān)。目征球結(jié)膜微循環(huán)檢查中各具體項(xiàng)目可提示相應(yīng)的臨床癥狀及抗體陽(yáng)性與否。微循環(huán)檢查可對(duì)SLE患者的一些臨床癥狀及受累臟器有一定的預(yù)測(cè)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.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R593.241

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