Microvascular abnormalities in patients with rheumatoid arthritis

Microvascular involvement represents one of the first apparent steps in many autoimmune diseases such as rheumatoid arthritis (RA). Early in the disease, peripheral microangiopathy may be easily recognized and studied by videocapillaroscopy. The aim of this study has been to observe the differences in labial microcirculation between healthy patients and patients suffering from RA. A total of 30 healthy patients and 30 patients suffering from RA were examined. The patients with conditions known to compromise microcirculation, such as diabetes, hypertension, or some pharmacological treatments were not included in the study. All the patients were non-smokers. Labial capillaroscopy was used to investigate the characteristics of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation was simple, non-invasive, and repeatable for each patient. In patients suffering from RA, it was possible to observe a reduced caliber of capillaries, as well as greater elongated capillaries, in comparison to controls. This study shows that capillary alterations in patients suffering from RA occur in labial mucosa microcirculation; such evidence could be extremely important in the diagnosis of suspected RA.     

Study of the microcirculation of oral mucosa in healthy subjects

The research has the following aims: 1: to verify the applicability of capillaroscopic investigation to oral mucosa; 2: to propose oral mucosa as an alternative to the fingernail fold for capillaroscopic investigation; 3: to describe the characteristics of the microcirculation of oral mucosa in healthy subjects. 100 healthy patients were examined. The characteristics of the micro-circulation in the areas of gum mucosa and the mucosa covering of the lower lip were examined using computerised videomicroscopic techniques. For each patient we evaluated the visibility, the course, the density, the tortuosity and any images characteristic of capillary loops, besides the possible presence of microhaemorrhages, the average calibre of capillary loops and the number of capillary loops visible per square millimetre. The investigation was simple, non invasive and repeatable for each patient. An investigation of gum mucosa has revealed a course of capillary loops both parallel and perpendicular to the surface: often the tops of the capillary loops appear as regularly distributed dots or commas. Microcirculatory architecture in the area of the mucosa covering is characterised by capillary loops with a variable diameter, course and length; next to typical capillary loops with the appearance of horse stirrups, there are other loops similar to hairpins, commas and cork screws; there are also rare microhaemorrhages with the aspect of reddish stains, that could be caused by microtraumas. Visibility was very good in the area of the mucosa covering of the lower lip: mediocre in the area of gum mucosa. Our research has highlighted, that today it is possible to carry out a capillaroscopic investigation of oral mucosa in a simple and reliable way. Future research could evaluate how "normal microcirculation", that we describe in this paper, is modified during pathology     

Modifications of interdental papilla microcirculation: a possible cause of periodontal disease in Hashimoto's thyroiditis?

BACKGROUND: Hypothyroidism is defined by a decrease in thyroid hormone production and thyroid gland function. The aim of the present research has been to evaluate the morphologic interdental papilla microcirculation of patients suffering from Hashimoto thyroiditis (HT) and to evaluate a possible correlation with the associated periodontal disease. METHODS: Fifteen healthy subjects and 15 patients suffering from HT were examined. The patients who showed conditions known to compromise microcirculation, such as diabetes, hypertension and pharmacological treatments, were not included in the group of healthy patients. All patients were non-smokers. Gingival capillaroscopy was used to investigate the characteristics of microcirculation. Visibility, course, tortuosity, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. RESULTS: An interdental papilla vascular modification results in HT. In patients suffering from HT, it was possible to observe a reduced caliber of capillaries, as well as a greater number and tortuosity of capillary loops. CONCLUSIONS: This study shows that capillary alterations in patients suffering from HT occur in gingival microcirculation.     

Microvascular characteristics of the human filiform papillae: a videocapillaroscopic study

The aim of this study was to observe the microcirculation characteristics of the human filiform papillae in healthy patients in vivo. Twenty healthy patients were examined using lingual capillaroscopy to investigate the characteristics of microcirculation of the human filiform papillae. Visibility, course, tortuosity, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation was simple, non-invasive and repeatable for each patient. Microcirculation architecture was characterized by a network of capillaries in polygonal mesh with parallel orientation in regard to the surface. Rare microhemorrhages were observed. The caliber of visible capillary loops was 12.50 +/- 1.46 microm (mean +/- SD). The number of visible capillaries was 9.88 +/- 1.06 (mean +/- SD). Our study shows that capillaroscopy of lingual filiform papillae is a practicable method. Future studies might evaluate whether microcirculation in that area is compromised or not during systemic pathologies involving peripheral microcirculation alterations. This method could also be applied to the study of microcirculation in pathologies which strictly pertain to the dental stomatological field.     

吸、戒烟对人体甲襞微循环的影响

对３０例吸烟者、３０例有吸烟史现戒烟者以及３０例无吸烟史者行甲襞微循环观测。结果表明，吸烟组甲襞微循环有明显改变，总积分值高于戒烟组和无吸烟的对照组（Ｐ＜００１）。其主要改变为：管袢输入枝、输出枝管径增宽，管袢扭曲、分叉，血流速度减慢，红细胞聚集度增加。戒烟组各项指标均明显改善，但与吸烟组比较差异显著（Ｐ＜００１）。与对照组比较，其形态改变尚未完全恢复（Ｐ＜００１）。以上结果提示，吸烟可引起机体的慢性微循环障碍，戒烟可对其造成的损害有所改善     

In vivo assessment of human nail fold capillary diameter

By using a videomicroscopy system, images of toe nail fold capillaries from 33 male smokers with atherosclerosis, 19 healthy male smoker controls, and 19 healthy male nonsmoker controls were recorded on video tape. Control subjects did not have clinical evidence of atherosclerosis. Capillary diameters were measured from the video tape with an image shearing device. The mean diameters (± SD) for the atherosclerotic patients, nonsmoker controls, and smoker controls were 13.7 μm (± 4.7 μm), 11.1 μm (± 3.4 μm), and 9.6 μm (± 3.4 μm), respectively. Statistical difference between the atherosclerotic patients and nonsmoker controls was significant at P<0.02; the difference between the atherosclerotic patients and smoker controls was significant at P<0.001. Statistical difference between the two control groups was not significant. These data indicate that atherosclerotic lesions elicit chronic dilation of distal cutaneous capillaries in patients who are smokers. However, comparison of these patients with tobacco smokers who are asymptomatic for atherosclerosis suggest that capillary dilation in atherosclerosis is attributable to the disease process itself and not to the effects of cigarette smoking. This dilation of cutaneous capillaries in the atherosclerotic toe nail fold may be caused by angiogenic factors released secondary to chronic ischemia.     

吸烟对健康人足甲襞微循环的影响

目的 探讨吸烟对健康人足甲襞微循环（FNM）的影响.方法 采用WX-9B型微循环显微镜及图像处理系统,对50名健康吸烟者和50名健康未吸烟者进行FNM 19项指标的观测,然后对两组检测结果进行比较.结果 与非吸烟组比较,吸烟组输人枝、输出枝增长（P〈0.05）,输入枝、输出枝和襻顶直径增大（P〈0.05）,管襻畸形率升高（P〈0.05）,血液流动慢（P〈0.05）、红细胞聚集增加（P〈0.05）,血管襻周围渗出增多（P〈0.05）,乳头下静脉丛出现率升高,真皮乳头平坦者增多（P〈0.05）,汗腺导管数量增多（P〈0.05）.结论 健康吸烟者存在一定程度的FNM改变,建议检测FNM时要考虑吸烟的影响.     

用注射复型扫描电镜方法观察足月胎儿胆囊微血管的构筑

用甲基丙烯酸甲酯铸型方法,将胎儿胆囊壁微血管制成铸型扫描电镜样品,脱水、干燥后,用EIKO IB-3型离子镀膜仪镀膜,在扫描电镜下观察。胆囊壁微血管明显分为三层,即浆膜层血管、肌层血管和粘膜层血管。其中浆膜和肌层血管与肠管壁相应层次的血管结构类似。而粘膜层血管则被分为两部分,一部分紧贴上皮细胞下,有一层丰富的毛细血管网;另一部分在固有膜内有管径粗大的静脉丛。毛细血管网与静脉丛之间直接以毛细血管相连。微动脉的数量相对较少,穿行于静脉丛之间,并逐级分支延续于毛细血管网。本文未见有动、静脉吻合。但在微动脉与静脉丛之间,常见有构成功能性毛细血管短路的毛细血管性交通支。     

雷诺现象患者的区域血流量及微循环变化

目的:探讨雷诺现象(RP)患者甲襞区域血流量和微循环的变化。方法:对30例RP患者和34例健康对照者进行甲襞区域血流量和甲襞微循环(NFM)检测。结果:RP患者的甲襞区域血流量明显低于健康对照组(P<0.01)。RP患者NFM检测中见管袢模糊不清,管袢缩短,交叉管袢增多,出现宽大畸形管袢,血流速度减慢,多呈粒流、粒线流,血管运动性增强,红细胞聚集多呈中、重度,乳头浅平,汗腺导管增多,血色暗红,严重者袢周有渗出、出血;管袢数减少,输入枝、输出枝、袢顶均增宽;与健康对照组相比有显著性差异(P<0.01)。RP患者NFM积分值明显高于健康对照组(P<0.01)。结论:甲襞区域血流量检测和微循环检查有助于判断RP患者的病情和预后。     

微循环障碍与激素性股骨头坏死相关性实验研究

目的 研究激素性股骨头坏死的发病原因。方法 用糖皮质激素诱导出股骨头缺血坏死的兔子模型,对比检测实验组和对照组的微循环状况以及与微循环有关的毛细血管内血液的流速,血液粘滞度,成份改变和病理组织学改变,弄清发病的主要相关因素。结果 实验组毛细血管中红细胞聚集,血液流速明显缓慢;血脂、血浆蛋白含量增高;股骨头内毛细血管数量减少,血管襻迂曲变长。结论 激素性股骨头缺血坏死的发病与微循环障碍有明显的关系。     

偏头痛患者血液微循环特征探讨

目的 探讨偏头痛患者的血液微循环特征。方法 观察50例偏头痛患者的红细胞流变性、血液流变性及甲襞微循环变化，并与50例健康人作对照。结果 偏头痛患者红细胞流变性异常，表现为红细胞聚集性增高、红细胞变形性降低；血液黏度增高，呈高黏高凝状态；甲襞微循环异常，主要表现为流态异常、襻顶瘀血、异型管襻数量增多、红细胞聚集、管襻长度缩短、开放管襻数量减少、襻周渗出等。结论 红细胞流变性异常、血液呈高黏高凝状态、微循环障碍是偏头痛患者的血液微循环特征。偏头痛患者血液微循环的异常改变可能是偏头痛的病因之一。     

糖尿病的血液流变性改变与其微循环障碍的关系

目的：探讨糖尿病血液流变性与微循环的关系。方法：检测35例糖尿病患者甲壁微循环、血液流变指标，与35例正常人对照。结果：（1）非胰岛素依赖型糖尿病（NIDDM）组全血高、低切粘度和高、低切还原粘度及血浆粘度均显著高于对照组（P＜0．01～0．001），而胰岛素依赖性糖尿病（IDDM）组上述各粘度指标仅轻度增高（P＞0．05）；（2）糖尿病各组及不同并发症组均有微循环血流减慢，红细胞刚性增高、电泳率降低、聚集性增强，白色微血栓等指标显著异常（P＜0.05～0.001）；（3）NIDDM组及并发症组微血管畸形数增多，管袢长度增加，微血管周围有明显渗出及出血等形态和管周指标的改变（P＜0.05～0.001）。结论：（1）各型糖尿病患者均有不同程度微循环障碍及血液流变性异常。（2）甲襞微循环障碍与血液流变性异常有一定的相关性。     

系统性硬皮病微循环和血液流变性改变与分析

报道６２例系统性硬皮病的微循环、血液流变性和免疫学改变并分析三者间的关系。提出管袢＂棒状＂扩张的畸变很有特色，对早期诊断和鉴别、分型很有价值。管袢数目减少者占患者的４８．４％，ＲＢＣ聚集９８．１％，流速减慢９８．４％，袢顶出血８０．６％；低和高切变率下ηｂ升高者分别为３４．３％和２２．９％，ηｂ降低者分别为３７．１％和２０％。ηｐ升高者２５．７％，降低者１１．４％；ＡＮＡ阳性者６９．４％，ＩｇＧ３８．７％、补体Ｃ４５９．６％、Ｃ３１９．１％、Ｙ－球蛋白３５．４％升高。统计学表明ＡＮＡ阳性组ηｐ高于ＡＮＡ阴性组，Ｐ＜０．０５。分析认为抗体的产生是血液流变性改变的原因，后者又引起微循环的异常。     

Anatomical evaluation of oral microcirculation: Capillary characteristics associated with sex or age group

BackgroundThere are various types of oral mucosa specific to different parts of the mouth and each of these has a unique histological structure. The variations in the epithelial structure are consistently related to observable differences in the underlying microcirculation: i.e. differences in the course, conformation, and density of capillaries. The aim of this research has been to investigate oral microcirculatory differences between men and women as well as between various age groups, in order to map the oral mucosa, and to highlight changes occurring during aging.MethodsA total of 45 healthy subjects were enrolled for this study (12 men and 33 women; mean age 60.37; range 30–82). A complete in-vivo videocapillaroscopic mapping of the oral mucosa was done on each subject.ResultsThe capillaroscopic patterns of the various areas differ particularly in the course of the loops in relation to the mucosal surface. On the basis of statistical analysis of the collected data, it emerges that there are many differences in capillary loop density between men and women and between different age groups.ConclusionThis study demonstrates the necessity of approaching the investigation of patient microcirculation in different ways depending on sex or age.     

山莨菪碱治疗前后糖尿病足坏疽病人的甲襞微循环变化

观察１２０例糖尿病足坏疽患者加用山莨菪碱治疗前后的甲襞微循环变化。结果表明：治疗前坏疽病人有不同程度的甲襞微循环障碍。山莨菪碱治疗后视野能见度有明显好转，清楚管袢、发夹形管袢、管袢数目增加，袢周和袢顶的出血、渗出减少或者消失；血液流态亦明显改善，团聚流减少（由８５．７％降至２４．３％）。管袢长度、宽度及输入、输出枝直径均有明显改善。甲襞微循环改善的同时，临床坏疽伤口也逐步好转、愈合，足坏疽的治愈率达８３．３％。山莨菪碱能改善糖尿病肢端坏疽病人的甲襞微循环障碍，对坏疽伤口的愈合有益。     

新正天丸对偏头痛血瘀证甲襞和球结膜微循环的影响

目的 :探讨偏头痛血瘀证病人甲襞和球结膜微循环的改变及新正天丸治疗后的影响。方法 :对照观察 3 6例偏头痛血瘀证病人发作期、治疗后和 2 8例正常人甲襞微循环 ,检测 2 8例偏头痛病人球结膜微循环 ,并与 2 6例正常人相比较 ,重点观察甲襞和球结膜微循环的形态、流态及血管袢周围状态等多项指标 ,并以加权积分法计算其积分值。结果 :与对照组相比 ,发作期存在明显的甲襞和球结膜微循环改变 ,主要表现在毛细血管管径缩小 ,管袢形态异常 ,袢周出血。经新正天丸治疗后 ,管袢清晰度增强 ,血流速度加快 ,红细胞聚集性下降 ,加权积分法示治疗前后甲襞和球结膜微循环有显著性改变 (P <0 .0 5～ 0 .0 1)。结论 :甲襞和球结膜微循环障碍可能是偏头痛血瘀证的重要病理特征 ,新正天丸对其微循环障碍可能有改善作用。     

高强度手部作业人群甲襞微循环的远期观察

目的:检测高强度手部作业人群甲襞微循环的远期变化。方法:使用ZL104型微循环检测仪及图像分析系统检测224例参加地震救援者(观察组)左手甲襞微血管形态、微血流流态和袢周状态,并对照正常参考值(正常组)进行比较分析。结果:观察组甲襞微循环异常者占全部受检者的36.16%,其甲襞微血管形态积分、流态积分、袢周状态积分及总积分分值均显著高于正常组(P<0.05)。结论:高强度手部作业对部分人群甲襞微血管形态及功能有远期影响。     

原发性心肌病的甲襞微循环

对原发性心肌病患者甲襞微循环状况进行初步观察，结果显示：１８例患者中有１６例均有不同程度的甲襞微循环异常改变（８８．９％），甲襞微循环加权积分均数３．９２±１．５５，以流态异常和血管袢畸形最为常见。     

Skin capillary abnormalities in patients with Raynaud's phenomenon

The digital skin microcirculation was studied by vital capillaroscopy in 32 consecutive patients with Raynaud's phenomenon. A detailed classification (stages 0-6) of the capillary abnormalities based upon observations of the capillaries in many different sites of the fingers was used. Associated diseases were searched for by an extensive clinical and immunological investigation. Seventeen (53%) of the patients had distinct structural changes in the capillaries but only 6 of them showed a restricted total digital circulation. Fifteen (88%) of these 17 patients displayed an underlying disease and/or immunological abnormalities. The corresponding figure for patients with mild or no capillary changes was 40% (p less than 0.01). Thus, the presence of marked (greater than or equal to stage 3) skin capillary abnormalities seems to be a good indicator of an associated systemic disease. The majority of patients in this category improved their capillary status during successful treatment of the underlying disease. We conclude that the form of capillaroscopy used in this study is a sensitive method for evaluating disturbances of the skin microcirculation in patients with Raynaud's phenomenon. The method may also contribute to the clinical evaluation of patients with this syndrome by identifying those with an underlying systemic disease.     

不同病程2型糖尿病患者甲襞微循环状态比较

目的:观察不同病程2型糖尿病(T2DM)患者甲襞微循环障碍程度。方法:600例住院T2DM患者,依病程分为新诊断组、3月～5年组、6年～10年组和>10年组。选取30例健康体检者为对照组。用徐州产HD-WX-10型微循环显微仪,在22～24℃室温下,检测所有对象的左手无名指,观察甲襞微循环形态、流态和袢周状态,并对各组加权积分值、不同程度异常率和部分指标异常进行统计学分析比较。结果:(1)不同病程各组T2DM患者甲襞微循环形态、流态和袢周状态积分均高于对照组,以管袢减少、白微栓、渗出和出血等改变较明显(P<0.01),中度异常患者比例较高。(2)病程10年以内各组患者积分值、部分指标异常率及异常程度无统计学差异(P>0.05)。(3)>10年组患者甲襞微循环流态及袢周形态积分和总积分较其它组增加(P<0.05),中度异常患者比例较高(P<0.01),管袢明显减少,白微栓和渗出显著增多(P<0.01)。结论:T2DM患者存在微循环障碍,病程>10年者较重。