Relevance. In this article, the authors draw the attention of readers to the modern possibilities of using the biomicroscopy of the bulbar conjunctiva (BMBC) method in the diagnosis of microcirculatory (MC) disorders in systemic sclerosis (SS). Comparison of BMBC results of patients with SS with a control group allowed us to identify microcirculatory signs of this disease, and comparison the changes detected during nail capillaroscopy (NC) showed additional diagnostic capabilities of the BMBC method. The aim of the study was to identify new MC signs in SS using the BMBC-method, which can be further used to assess the dynamics and search for patterns with the clinical picture. Materials and methods. 48 patients with SS, the average age was 51±1.7 years were examined by BMBC, the ratio of women to men was 46:2, respectively. The control group consisted of healthy individuals without any diseases that could affect to the microcirculatory bed (MCB); the average age was 47.4±2.3 years, and the ratio of women to men was 20:10. The results showed statistically significant changes in angioarchitectonics among patients with SS compared with the control. A significant decrease in the average diameter of arterioles (14.1±0.7 μm) and capillaries (6.6±0.2 μm) was observed in the group of patients with SS compared with the control (16.6±0.6 μm, p=0.0165 and 7.3±0.2 μm, p=0.0356, respectively, for arterioles and capillaries). The decrease in capillaries during SS in four regions of the temporal section of the bulbar conjunctiva was incremental and amounted to: 15.3% in the area of the angle of the eye, 23.3% in the transitional region, 28.1% in the central and 37.9% in the perilimbal in comparison with the control. Conclusions. The BMBC-method is highly informative in the diagnosis of MC-disorders in SS. The main BMBC changes in the MC disorders caused by SS are the disturbance of MCB by the increasing tortuosity of microvessels, the contour discontinuity and the presence of local wall extensions. A peculiarity is the reduction of the capillary bed in all four regions of the temporal section of the bulbar conjunctiva with a maximum in the perilymb area.
Microcirculatory (MC) disorders in systemic sclerosis (SS) are an important part of pathogenesis, morphogenesis, determine the clinical picture of the disease, the severity of the patient’s condition and prognosis. The authors draw attention to a direct method for studying microcirculatory disorders – conjunctival biomicroscopy (CBM). The use of improved equipment for conducting CBM and the survey algorithm allows at the present stage to improve the quality of the data obtained, to simplify and standardize the CBM procedure, to record and analyze new MC predictors.The study of the correlations between MC changes identified in CBM in patients with SS, with the data of the clinical picture, will make it possible to determine a limited set of the most significant MC parameters, simplify the analysis of primary CBM data and take a fresh look at the CBM method, rethinking its diagnostic capabilities SS, which determined the aim of this study.Materials and methods. In 48 patients suffering from SS (mean age 51±1.7 years), MC was studied by the direct method – conjunctival biomicroscopy. Quantitative parameters of MC are compared with the clinical manifestations of SS by the methods of linear Pearson correlation and Spearman non-linear correlation. The critical value of the level of statistical significance in testing null hypotheses was taken to be 0.05.Results. The main clinical manifestations of SS: the duration of the disease (months), skin count (points), the activity of the disease (points), the duration of skin syndrome (months) and the duration of vascular syndrome (months) showed statistically significant linear and non-linear correlation with seven MC parameters: the value of the arteriolo- to-venule ratio (AVR), five parameters characterizing the density of capillaries on the bulbar conjunctiva and the average diameter of capillaries.Conclusion. A limited set of the most informative MC signs in the form of AVR and the number of capillaries in various areas of the temporal section of the bulbar conjunctiva greatly simplify the interpretation of CBM data and allow a new look at the diagnostic capabilities of the “old” method in SS. A promising direction, in our opinion, is the further study of the indicated MC parameters and the identification of possible correlations with the data of laboratory, instrumental methods of research and assessment of the dynamics of the indicated MC parameters in case of SS.
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