Autologous stem cell transplantation improves microcirculation in systemic sclerosis

被引：81

作者：

Miniati, I. ^{[1
]}

Guiducci, S. ^{[1
]}

Conforti, M. L. ^{[1
]}

Rogai, V. ^{[1
]}

Fiori, G. ^{[1
]}

Cinelli, M. ^{[1
]}

Saccardi, R. ^{[2
]}

Guidi, S. ^{[2
]}

Bosi, A. ^{[2
]}

Tyndall, A. ^{[3
]}

Matucci-Cerinic, M. ^{[1
]}

机构：

[1] AOUC, Dept Biomed, Div Rheumatol, DENOthe Ctr, Florence, Italy

[2] AOUC, Bone Marrow Transplantat Unit, Florence, Italy

[3] Univ Basel, Dept Rheumatol, Basel, Switzerland

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2009年 / 68卷 / 01期

关键词：

ENDOTHELIAL GROWTH-FACTOR; NAILFOLD CAPILLAROSCOPY; RAYNAUDS-PHENOMENON; PULMONARY-FIBROSIS; CYCLOPHOSPHAMIDE; SCLERODERMA; DISORDERS; PLACEBO; DISEASE; ANGIOGENESIS;

D O I：

10.1136/ard.2007.082495

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: In systemic sclerosis (SSc) reduced capillary density decreases blood flow and leads to tissue ischaemia and fingertip ulcers. Nail fold videocapillaro-scopy (NVC) is a diagnostic and follow-up parameter useful to evaluate the severity, activity and the stage of SSc microvascular damage. Autologous haemopoietic stem cell transplantation (HSCT) is a new treatment for patients with severe diffuse cutaneous systemic sclerosis (dcSSc) refractory to conventional therapies. We aimed to evaluate the improvement of microvasculature after HSCT using NVC. Methods: A total of 16 patients with severe dcSSc with a "late'' videocapillaroscopy pattern underwent an immunesuppressive treatment: 6 were treated with HSCT and 10 with monthly pulse cyclophosphamide (CYC) 1 g for 6 months and then orally with 50 mg/day for further 6 months. NVC was performed before and after 3 months from the beginning of each treatment and then repeated every 3 months. Results: In all patients, before HSCT NVC showed large avascular areas and ramified capillaries and vascular architectural disorganisation ("late'' pattern). At 3 months after HSCT, the NVC pattern changed from "late'' into "active'', showing frequent giant capillaries (>6/mm) and haemorrhages, absence of avascular areas and angiogenesis phenomena; 1 year after HSCT, microvascular abnormalities were still in the "active'' pattern. In patients treated with CYC, no NVC modifications were observed during 24 months of follow-up and the pattern always remained "late''. Conclusions: These results indicate that HSCT with a high dose CYC regimen may foster vascular remodelling, while CYC at lower doses and with a chronic regimen does not influence the microvasculature.

引用

页码：94 / 98

页数：5