甲褶鏡應用於辨病與辯證之文獻回顧－－以全身性硬化症與紅斑性狼瘡為例

A REVIEW OF NAILFOLD CAPILLAROSCOPY FOR DIFFERENTIAL DIAGNOSIS AND PATTERN IDENTIFICATION IN SYSTEMIC SCLEROSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS

在許多風濕免疫疾病的初期，輕微的病變難以被發現，然而等到病徵顯著時，往往疾病已重，難以獲得良好的控制。全身性硬化症（SSc）與紅斑性狼瘡（SLE）皆屬全身性自體免疫疾病，常造成血管病變，臨床上常併發雷諾氏現象，在疾病早期臨床醫師往往難以鑑別診斷。甲褶鏡可藉由觀察甲褶微血管形態及流速上的異常，進而偵測到疾病早期即出現的血管病變，幫助早期診斷全身性自體免疫疾病。本文搜尋近年來使用甲褶鏡觀察SSc與SLE患者甲褶微血管形態異常之進展，以提供臨床診療之參考。有文獻報告顯示：分析甲褶微血管變形之類別，可在發病早期鑑別診斷SSc與SLE。由中醫辨證診斷觀點進行分析，結果顯示SLE氣滯血瘀症患者雷諾氏現象最明顯，甲褶微循環異常之積分最高。微循環積分對應了氣滯血瘀證，未來可作為中醫辨證的客觀指標之一。另有研究應用甲褶微循環指標評估中西醫結合治療SSc之療效，認為其屬中醫血瘀證之一種，其結果可引起微循環血流障礙，而活血化瘀是其治療的重要方向。中醫證型與微血管變形類別之間的關係則尚待研究。Early diagnosis is challenging but necessary in rheumatic diseases because satisfactory management is often difficult to achieve at a more advanced stage. Systemic sclerosis (SSc) and systemic lupus erythematosis (SLE), difficult to differentiate in early stages, are examples of autoimmune disorders often complicated with vascular disorders such as Raynaud's phenomenon. Nailfold capillaroscopy is a tool that can early detect the vascular changes that appear in some autoimmune disorders by identifying abnormalities in capillary morphology and speed of capillary blood flow. In this article, a review of using nailfold capillaroscopy for study of vascular condition in SSc and SLE is presented, hoping to provide help in clinical diagnosis. It is reported that SSc and SLE can be diagnosed in the early stages through morphological observation of nailfold capillary. Raynaud’s phenomenon, with the highest score of nailfold microcirculation abnormality, is most common in SLE patients who are categorized as blood stasis due to qi stagnation in TCM pattern identification. These results indicate that the score of nailfold microcirculation is correlated with the pattern of blood stasis due to qi stagnation, and has the potential of becoming an objective indicator for TCM pattern identification. There is also research that utilize nailfold capillaroscopy to estimate treatment efficacy for SSc patients participating in a Chinese and western medicine integrated treatment program. In the study, SSc is considered a type of the TCM blood stasis pattern that may lead to problems with blood circulation, and therefore is to be treated with quickening the blood and transformation of stasis. More study is needed to clarify the relationship between TCM patterns and types of capillary changes.