紅斑性狼瘡表現雷諾氏症候群患者其血液黏稠度受溫度之影響的研究

Study of the Effect of Temperature on Blood viscosity in Systemic Lupus Erythematosus with Raynaud's Phenomenon

雷諾氏症候群之形成原因一般認係血管受冷刺激後過度收縮所致，然而血流除受血管口徑大小的影響之外；亦受壓力及血液黏稠度的影響。過去的報告發現雷諾氏症候群的病人之血液黏稠度較正常人為高，但這些研究報告是以原發性雷諾氏症候群或是硬皮症患患者為研究對象的。吾人利用同心圓柱黏稠度儀測定紅斑狼瘡而有雷諾氏症候患者之37°C及低溫下的血液黏稠度。由於患者之血球容積率較正常人為低故37°C下之血液黏稠度並未高於正常人，而低溫下則紅斑性狼瘡患者之血液黏稠度大幅度增加，其增加幅度較正常人為高；而不管有無雷諾氏症候之存在，其增加的幅度近似。然而雖有較大幅度的增加，紅斑性狼瘡患者的血液黏稠度仍未達有意義的高於正常人。活體外所測得之血液黏稠度受血球容積率之影響最大，但在活體血管內血球容積率不是固定的，它隨著血管口徑的變小而減小。故若不考慮血球容積率的因素則低溫下患者之血液黏稠度的大幅增加很有可能是造成雷諾氏症候的影響因素之一，但血液黏稠度不太像是主要原因；因為紅斑性狼瘡患者不論有無雷諾氏症候均有在低溫下大幅度增加血液黏稠度之情形。

Blood viscosity was studied in patients with systemic lupus erythematosus by using the concentric cylinder viscometer. Higher blood viscosity was found in seven patients with Raynaud's phenomenon than those of seven patients without the symptom. However, blood viscosity of patients with Raynaud's phenomenon was not higher than normal controls due to lower hematocrit. At low temperature, blood viscosity of patients with Raynaud's phenomenon increased to a greater extent than normal controls, but was still not significantly higher than the normal. However, if the influence of hematocrit on blood viscosity decreased due to Fahraeus-Lindqvist phenomenon in small vessels, blood viscosity of patients with Raynaud's phenomenon might be higher than the normal. In conclusion, vasospasm caused by cold exposure reduced blood flow, the resultant low shear rate and the effect of low temperature would increase blood viscosity and contribute to the pathogenesis of Raynaud's phenomenon.