以甲褶微血管鏡檢查評估全身紅斑性狼瘡有／無合併抗磷脂抗體

Nailfold capillaroscopy in evaluation of systemic lupus erythematosus with / without positive antiphospholipid antibodies

目的：甲褶微血管鏡檢查（甲褶鏡）較少在全身紅斑性狼瘡及與其相關抗磷脂抗體症候群進行研究。過去已經有研究顯示在有雷諾氏現象患者，甲褶鏡的型態區別可協助診斷紅斑性狼瘡。本篇是一個回溯性研究，探討紅斑性狼瘡患者有無合併抗磷脂抗體，在甲褶鏡表現之型態，以協助預測紅斑性狼瘡合併抗磷脂抗體症候群。方法與結果：我們搜尋一個大學醫院資料庫中，從西元2007年到2011年，總共有33位紅斑性狼瘡病患有接受甲褶鏡檢查。這些紅斑性狼瘡患者74%臨床上有雷諾氏現象。甲褶鏡的「紅斑性狼瘡型態」用於有無抗磷脂抗體相關性的敏感性為70%；特異性為76.9%；陽性預測值為70%；陰性預測值為76.9%。以費雪精確性雙尾檢定的p值為0.0397。我們也發現甲褶鏡的「紅斑性狼瘡型態」與血栓栓塞併發症有統計學意義（p值為0.0075）。結論：甲褶鏡檢查「紅斑性狼瘡型態」，這種以半定量指標的分類，可預測紅斑性狼瘡患者抗磷脂抗體陽性率易合併血栓栓塞。而且如我們這個研究所顯示，甲褶鏡的發現比抗磷脂抗體陽性與血栓栓塞併發症更有顯著相關性，甲褶鏡可協助診斷血清陰性抗磷脂抗體症候群。

Objective: The use of nailfold capillaroscopy (NC) in cases of systemic lupus erythematosus (SLE) and associated antiphospholipid syndrome (APS) has seldom been studied. NC has shown a very high specificity at pattern recognition in assistance of diagnosis of SLE in patients presented with Raynaud's phenomenon (RP). Herein we address the characteristic NC findings in SLE patients with/without positive antiphospholipid antibodies (aPL) in a retrospective study to evaluate the feasibility of NC in predication of SLE associated APS. Methods and Results: A total of 33 patients with SLE in a university hospital who had received an NC exam from 2007 to 2011 were enrolled in our study. The observed frequency of RP in SLE was 74 %. For antiphospholipid positivity association evaluation, the presence of SLE NC pattern in this study revealed 70% sensitivity, 76.9% specificity, 70% PPV (positive predictive value), and 76.9% NPV (negative predictive value). The two-tailed p value by Fisher’s exact test was 0.0397. A statistically significant association of thromboembolic events between SLE NC patterns was also found (p=0.0075). Conclusion: The semi-quantitative parameters for the classification of a SLE pattern at NC were predictive of aPL positivity and thromboembolic complications in patients with SLE. The significant association between thromboembolism in patient with SLE and their NC findings in our study suggested that NC study would be helpful in the diagnosis of seronegative APS.