Abstract
The aim of this study was to analyze the relationship between the qualitative abnormalities on nailfold videocapillaroscopy (NVC), and the concentrations of selected biomarkers (sE-selectin, endothelin-1, high-sensitivity c-reactive protein (hsCRP)) and lipid metabolism parameters in children and adolescents with Raynaud’s phenomenon (RP). Raynaud’s phenomenon, to assess whether nailfold capillary changes may reflect the degree of systemic blood vessel abnormalities. The study group included 66 patients (34 undifferentiated—uRP and 32 secondary—sRP) aged 6–19 years and the control group. In both groups, NVC was performed and the selected biomarkers were measured (sE-selectin, endothelin-1, hsCRP) and lipid profile. Endothelin-1, sE-selectin and hsCRP concentrations in patients from both RP groups were significantly higher; concentration of HDL fraction was significantly lower compared with the control group. The analysis of multiple linear regression demonstrated that megacapillaries most strongly determine the sE-selectin value (p = 0.04) and hsCRP (p = 0.03). Both the total cholesterol and low-density lipoprotein (LDL) fraction concentrations were determined by the presence of avascular areas (p = 0.02). In conclusion, specific pathologic NVC changes were associated with higher endothelial damage biomarkers concentration and adverse changes in the lipid profile.
Highlights
Microcirculation is an important, still relatively insufficiently known component of the cardiovascular system, both in a structural and functional respect [1,2,3].Clinical manifestation of peripheral microcirculation disorders is a Raynaud’s phenomenon (RP), which may precede autoimmune connective tissue diseases (CTDs) many years, or accompany them [4].RP consists of three phases, namely the ischemic phase, cyanotic phase and erythema phase
The degree of abnormalities on nailfold videocapillaroscopy (NVC), clinical assessment, RP history, and serological status enabled distinguishing between two RP subtypes: Undifferentiated RP: 34 patients with nonspecific NVC changes and without signs of systemic connective tissue disease (CTD) [5,27]
In the opinion of some authors, the abnormal capillaroscopic pattern can be seen in healthy children in as much as 15–37% of cases [30,31]
Summary
Microcirculation is an important, still relatively insufficiently known component of the cardiovascular system, both in a structural and functional respect [1,2,3]. RP consists of three phases, namely the ischemic phase, cyanotic phase and erythema phase. The vasoconstriction of pre-capillary sphincters of the digital arteries and arterioles induced by cold and/or emotional stress determines the initial marked pallor (ischemic phase); pre-capillary sphincters relax due to hypoxia and accumulation of anaerobic products, determining a hyper-flow of blood in ischemic areas, with a rapid hemoglobin desaturation (cyanotic phase); a pre and a post-capillary sphincter dilatation induces a reactive, often painful, hyperemia (erythema phase). An established method for the evaluation of structural abnormalities of the microcirculation is the nailfold videocapillaroscopy (NVC). The computerized analysis of images of the microcirculation and the possibility of data storage enable assessment of the dynamics of changes taking place over time [5,6,7]
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