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dOI 10.11603/IJMMR.2413-6077.2019.2.10671

CONNECTIVE TISSUE DISEASES: FOCUS ON MICROCIRCULATORY BED

*O.I. Zarudna, I.K. Venher, A.V. Dovbush
I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE

Background. A microcirculatory bloodstream is a target, source and reason of the pathological process in 
patients with systemic connective tissue diseases. 

Objectives. This study is focused on meta-analyses of biopsy material of skin flaps harvested from patients’ 
fingers to identify specific morphological changes. 

Methods. A retrospective analysis of the medical records of 39 examinees with systemic sclerosis (SSc), 45 
with Systemic Lupus Erythematosus (SLE), and 45 with rheumatoid arthritis (RA) was performed. The condition of 
peripheral hemodynamics was examined with longitudinal rheovasography of arms and legs. Endothelin-1 (ЕТ1) 
concentration was evaluated by immunoenzymatic method. We assessed other results of clinical and laboratory 
tests to compare them with morphological changes of the microcirculatory bed.

Results. Most patients involved suffered from abnormal peripheral hemodynamics. It was revealed that 
kidneys, lungs or heart were damaged more frequently in the patients with peripheral blood circulation disorders, 
which were the most significant in the patients with SSc (p<0.05). Disorders of peripheral blood flow were 
exacerbated in case of lengthening of the disease course. Concentration of ЕТ1 was relevantly higher in the 
patients with peripheral blood flow disorders. Number of pathologic capillaries was the highest in the SSc patients. 

Conclusions. In terms of integral estimation, extremely significant changes of microcirculatory bloodstream 
were evidenced in the patients with SSc. However, some morphometric peculiarities were revealed in the patients 
without peripheral blood flow disorders. Thus, normal rheovasography did not exclude any microcirculation 
disorders. 

KEY WORDS: microcirculation; systemic lupus erythematosus (SLE); systemic sclerosis (SSc); 
rheumatoid arthritis (RA); biopsy; rheovasography.

*Corresponding author: Olga Zarudna, Department of Clinical 
Immunology, Allergology and General Patients’ Care, I. Hor-
bachevsky Ternopil National Medical University, 1 Maidan Voli, 
Ternopil, 46001. 
E-mail: zarudna@tdmu.edu.ua.

Introduction 
Manifestations of systemic connective 

tissue diseases are very diverse. However, one 
thing they all have in common is vasculitis/
vasculopathy that results in systematicity and 
development of permanent malfunctioning of 
body organs and systems. Several studies show 
that patients with systemic lupus erythematosus 
(SLE), systemic sclerosis (SSc), and rheumatoid 
arthritis (RA) experience such symptoms as 
Raynaud syndrome, livedo reticularis, recurrent 
thrombophlebitis, digital vasculitis, capillaritis 
of palms and soles, etc. Among the manifes-
tations listed above the most common sign is 
Raynaud syndrome that is characterized by 
cascade disruption of microcirculation: destruc­
tion of vascular endothelium, capillary basement 
membrane reduplication, intimal proliferation 
of smooth muscle cells with collagen hyperpro-
duction and predisposition to vasoconstriction, 
vascular wall thickening with luminal occlusion, 

which is manifested by generalized clinical 
symptoms. Meanwhile, endothelium is a target, 
source and reason of the pathological process. 
It becomes a receptive field for binding of 
circulating immunoglobulins, immune comp-
lexes, a complement and attacks of sensitized 
T-lymphocytes. It itself produces vascular 
endothelial growth factor, endothelin 1, etc. 
Similar findings are presented in the literature 
[1, 2, 3, 4].

Numerous studies have been conducted in 
order to identify noninvasive methods of 
studying microcirculatory bloodstream and 
detect specific pathological characteristics in 
favour of one or another connective tissue di-
sease to help confirm a diagnosis. Consequently, 
the method of nailfold videocapillaroscopy is 
relevant [5, 6, 7]. Moreover, the results of nail-
fold videocapillaroscopic examination are 
included into diagnostic classification by EULAR 
criteria of systemic sclerosis [5], indicating their 
high specificity and sensitivity. 

For an overall assessment of capillaroscopic 
pattern, the following indicators are used: 
capillary length, intercapillary distance, loop 
diameter, internal diameter, capillary width, 

International Journal of Medicine and Medical Research 
2019, Volume 5, Issue 2, p. 32-39
copyright © 2019, TNMU, All Rights Reserved

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apex width, venous limb, arterial limb [7]. Data 
analysis shows typical changes, for example, 
SSc: giant capillaries, loss of capillaries with 
areas of avascularisation, ramified capillaries 
with pathological neoangiogenesis and severe 
derangement of capillary structure [5]. Nailfold 
capillaroscopic form changes are less sympto-
matic in cases of other diseases, for example 
in SLE. According to the literature concerning 
the above-mentioned pathology, they are 
present in 30-75% of cases. SSc (in contrast to 
SLE) characteristically reveals these changes 
that occur in 99% of cases at various stages [5, 
6]. The most frequent alterations in the patients 
with SLE include increased tortuosity, elongated 
loops, and meandering bizarre loops [5]. The 
patients with RA are reported to have increased 
capillary tortuosity and prominent, clearly 
visible subpapillary venous plexus [5]. At the 
same time, according to the study of auto im-
mune processes, in some pathological con di-
tions, correlation between the rate of biolo gi-
cally active substances and results of capilla-
roscopy was revealed. For example, in cases of 
SLE a relation between concentration of endo-
thelin­1 (ЕТ­1) and angioscopic characteristics 
of microcirculatory bloodstream (MCB) was 
found [8]. Meanwhile, increase in anti-endo-
thelial antibody titre in cases of SSc was present 
in 22-86% of cases and combined primarily with 
lung damage and peripheral vascular bed [4].

 A few researches describe the results of 
immune histochemical tests that allows estab-
lishing that CD20+, B-lymphocytes, macropha-
gocytes and dendritic cells, Ig G, A, M, and a 
complement in the form of deposits along 
elastic membrane of a vascular wall prevail 
among the cells that infiltrate a vessel wall [9].

The revealed morphological abnormalities 
and immunological disorders in systemic di-
seases of connective tissue combined with 
endothelial dysfunction and coagulation sys-
tem disorders create favourable conditions for 
development of severe systemic complications.

The research is aimed at a retrospective 
study of morphological condition of a peripheral 
vascular bed in the patients with SLE, SSc, and 
RA to compare morphological changes with 
clinical and laboratory data. 

Methods 
Retrospective analysis of the medical re cords 

of 129 patients with rheumatic diseases was 
performed: 39 were diagnosed with SSc, 45 – 
with SLE, and 45 – with RA (all were the patients 
of Ternopil University Hospital, Depart ment of 

Rheumatology, 2001-2004). The statistical 
analysis revealed a typical situation for this 
category of diseases – predominance of women 
(86.05%) of fertile age. The average duration of 
the disease was 8.14±0.53 years. The archive of 
biopsy material of skin flaps harvested from 
patients’ fingers was reviewed that allowed 
morphometric analysis. The de cision for biopsy 
was made by a rheumatologist during the 
treatment at the Department of Rheumatology. 
For histological studies, pieces of skin were fixed 
in 10% neutral formalin solution. Subsequent 
processing of the material followed by embed-
ment in paraffin blocks was carried out by a 
conventional technique. The sections obtained 
by a sliding microtome were stained with 
hematoxylin-eosin. The histological specimens 
were studied using the optical microscope SEO 
SCAN and images were made with the Vision 
CCD Camera with a histological image display 
system. The condition of peri pheral hemody-
namics was examined by longi tudinal rheovaso-
graphy of forearm and legs by means of soft-
ware-hard ware complex of automated analysis 
USRH­1 (“УСРГ­01”). In the process of rheovaso­
graphic analysis the following medical parame-
ters were estimated: the regularity of pulse 
waves, their appearance – upward and downward 
gradients, the type of a top (apex), extent of 
incisura, presence of additional waves, their 
localization on the de scending part of a curve. 
The following measu rements were analysed: 

As – percussion systolic wave amplitude of 
a rheogram, Ohm;

RІ – rheographic index, that measures a 
magnitude of pulse volume, in other words a 
systolic flow; that is a correlation of a variable 
and a constant dimensions of impedance of the 
researched area, namely, a percussion wave of 
a rheogram and calibration impulse magnitude, 
relative units (RU); 

Ai – interval between the isoline and incisu-
res on the descending part of a curve, Ohm;

DI – dicrotic index, which reflects the con­
dition of the tone of arteries and precapillary 
vessels, %.

The main indicator that was used for 
analysis was a rheographic index that measured 
the magnitude of pulse volume that was a 
systolic flow defined by a ratio of a percussion 
wave of a rheogram and calibration impulse 
magnitude, relative units (RU). 

The condition of endothelium was examined 
in terms of one of the main integral indicators 
of its functional capacity, i.e. ЕТ1. The contents 
of ЕТ1 were determined using an immuno­

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enzymatic method, which was based on the 
principle of competitive immunoenzymatic 
analysis, involving a reagent kit Peninsula 
Laboratories Inc. (USA). 

The severity of inflammation was deter­
mined by erythrocyte sedimentation rate 
(degree 1 – ESR <20 mm/hr, degree 2 – ESR 
20-40 mm/hr, degree 3 – ESR >40 mm/hr).

All case histories contained informed con-
sents for the research. The study was conducted 
in accordance with the Declaration of Helsinki. 
The Protocol was approved by the Committee 
on Bioethics of I. Horbachevsky Ternopil 
National Medical University. 

Statistical processing of the research results 
was performed by parametric analysis and non-
parametric analysis using the Student’s t-test 
and Mann-Whitney U-test by means of software 
package Microsoft EXCEL 5.0 and Statistica 10 
(StatSoft). p values lower than 0.05 were con-
sidered to be statistically significant.

Results
All cases were divided into two groups 

according to the state of peripheral hemo-
dynamics, which was examined using longi-
tudinal rheovasography of forearm and legs. 

The majority of patients, the model par-
ticipants of the research, had abnormal peri-
pheral hemodynamics (group 2). The ratio of 
the above-mentioned patients to the patients 
with normal peripheral hemodynamic para-
meters (group 1) was 5.1:1.0. Clinical assessment 
of the involved patients is presented in Table 1. 

Assessment of peripheral hemodynamics 
allowed revealing significant changes in indices 
of longitudinal rheovasography of forearms 
and legs (Table 2).

Morphometric analysis of skin biopsy was 
conducted in 26 model patients (Table 3, Table 4). 

Biopsy results of the patients with different 
nosology and peripheral blood circulation 
disorders are presented at Figures 1, 2, and 3. 

Notably, microscopic examination revealed 
that general architectonics of vessel walls was not 
damaged. Visible hyperplasia of endo the liocytes 
in all categories of patients was also evidenced, 
which may be treated as an adaptive mechanism 
in cases of blood circulation dis orders.

The results of patients’ blood tests for con-
centration of ЕТ1 (Table 5) pointed to its extre­
mely high content in the patients with peripheral 
blood circulation disorders in contrast to donors’ 
indices. 

Table 1. Clinical Assessment of the Patients with/without peripheral blood circulation disorders

Indicant

Patients
with normal peripheral 

hemodynamic parameters
(1st group)

with abnormal peripheral 
hemodynamics

(2nd group)
Absolute numbers % Absolute numbers %

Age (years):
under 20 
20-44 
45-59 
60 and above

3
9
5
4

2.3
6.9
3.9
3.1

4
53
38
13

3.1
41.1
29.5
10.1

Males
Females

6
15

4.7
11.6

12
96

9.3
74.4

SLE
SSc
RA

9
1

11

6.9
0.8
8.5

36
38
34

27.9
29.5
26.4

Activity of the 1st degree
Activity of the 2nd degree
Activity of the 3rd degree

2
15
4

1.6
11.6
3.1

52
41
15

40.3
31.8
11.6

Duration of a disease < 1 yr 
Duration of a disease 1-5 yrs
Duration of a disease 5-10 yrs
Duration of a disease >10 yrs

3
6
5
7

2.3
4.7
3.9
5.4

10
38
30
30

7.8
29.5
23.2
23.2

Kidney damage
No kidney damage

6
15

4.7
11.6

28
80

21.7
62.0

Cardiac involvement
No cardiac involvement

7
14

5.4
10.9

37
71

28.7
55.0

Lung damage
No lung damage

5
16

3.9
12.4

23
85

17.8
65.9

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At the same time, concentration of ET-1 in 
the patients without vessel disorders is not 
substantially different from normal range. 

Discussion
Among the examinees, the detection rate 

of peripheral hemodynamic disorders in the 

Table 2. Indices of peripheral blood circulation in the patients of group 2  
(with peripheral hemodynamic disorders)

Indices
Forearms Lower legs

As,
Ohm

RІ,
 RU

Ai,
Ohm

DI,
%

As,
Ohm

RІ,
RU

Ai,
Ohm

DI,
 %

Duration  
of disease

< 1 yr, n=10 0.123±
0.002*

1.23±
0.02*

0.090±
0.002*

73.41±
0.08*

0.147±
0.003*

1.47±
0.03*

0.105±
0.002

71.58±
0.08*

>1-5 yrs, 
n=38

0.091±
0.002*

0.91±
0.02*

0.075±
0.002

82.24±
0.06*

0.145±
0.002*

1.45±
0.02*

0.116±
0.002*

80.24±
0.03*

>5-10 yrs, 
n=30

0.087±
0.003*

0.87±
0.03*

0.074±
0.002

84.98±
0.08*

0.127±
0.003*

1.27±
0.03*

0.106±
0.003*

83.49±
0.04*

>10 yrs, 
n=30

0.085±
0.002*

0.85±
0.02*

0.074±
0.001

87.18±
0.05*

0.114±
0.003*

1.14±
0.03*

0.096±
0.002

86.26±
0.04*

Disease SLE,  
n=37

0.109±
0.002*

1.09±
0.02*

0.083±
0.002*

75.79±
0.05*

0.130±
0.002*

1.30±
0.02*

0.108±
0.008*

83.39±
0.04*

SSc,  
n=37

0.082±
0.002*

0.84±
0.02*

0.072±
0.002

85.73±
0.08*

0.113±
0.004*

1.13±
0.04*

0.095±
0.003

84.41±
0.06*

RA,  
n=34

0.089±
0.002*

0.89±
0.02*

0.070±
0.002

79.06±
0.06*

0.122±
0.003*

1.22±
0.03*

0.099±
0.003

81.11±
0.03*

Activity  
of the 

inflam­
matory 
process

1st degree, 
n=52

0.095±
0.002*

0.95±
0.02*

0.080±
0.002*

84.15±
0.05*

0.121±
0.004*

1.21±
0.04*

0.099±
0.002

81.60±
0.09*

2nd degree, 
n=41

0.095±
0.003*

0.95±
0.03*

0.080±
0.002*

84.17±
0.05*

0.113±
0.002*

1.13
0.02*

0.095±
0.002

84.15±
0.04*

3rd degree, 
n=15

0.105±
0.005*

1.05±
0.05*

0.080±
0.004

75.52±
0.07*

0.138±
0.002*

1.13±
0.02*

0.111±
0.002*

80.44±
0.06*

Follow-up control 0.152±
0.008

1.52±
0.08

0.069±
0.005

45.43±
0.04

0.181±
0.012

1.81±
0.12

0.088±
0.008

78.53±
0.07*

Notes. * – р<0.05 – statistically significant difference between the indices in apparently healthy people of the control group 
and other studied patients.
RA – rheumatoid arthritis; 
SSc – systemic sclerosis;
SLE – systemic lupus erythematosus.

Table 3. Average density of skin hemocapillaries of the patients per 1mm²

Groups
No peripheral blood circulation 

disorders
(group1, n=11)

Peripheral blood circulation 
disorders

(group 2, n=15)
Normal range 43.0±1.9 –

Rheumatoid arthritis,
n=8

40.0±1.8
p1>0.05

37.0±1.6
p1>0.05
р2>0.05

Systemic sclerosis,
n=8

38.0±1.7
p1>0.05

21.0±1.0
p1<0.01
p2<0.01

Systemic lupus erythematosus,
n=10

41.0±1.9
p1>0.05

36.0±1.7
p1<0.05
р2>0.05

Notes:
p1 – statistically significant difference between the normal range and average density of hemocapillaries per unit area in patients 
of both groups;
р2 – statistically significant difference between the indices in patients of the groups 1 and 2.

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patients with RA was 75.6 %, which is slightly 
higher than the established results of statistical 
researches. Peripheral blood circulation disor-
ders were diagnosed in the patients with SLE 
in 80 % of cases, in the patients with SSc – in 
97.4 % of cases, which is consistent with lite-
rature [10, 11]. 

Despite nearly equal distribution of patients 
in every group by age, duration of a disease, 
activity of the inflammatory process, it has been 
revealed that a kidney, lung or heart are da-
maged more frequently in the patients with 
peripheral blood circulation disorders. Such 
results are probably associated with the de-
velopment of systematicity, which is caused by 
peripheral blood flow and microcirculation 
disorders. 

Table 4. Distribution of skin hemocapillaries of the patients over the duct width

Disease

No peripheral blood circulation disorders
(group 1, n=11)

Peripheral blood circulation disorders
(group 2, n=15)

The number of hemocapillaries  
and their diameter

The number of hemocapillaries  
and their diameter

8­12 μm 15­25 μm above25 μm 8­12 μm 15­25 μm
above
25 μm

Normal range 100 – – 100 – –
Rheumatoid 
arthritis,
n=8 

80.6±3.6
р1<0.01

12.1±0.6 7.3±0.3 31.3±1.5
р1<0.01
р2<0.01

46.6±2.2 22.1±1.0

Systemic  
sclerosis,
n=8

71.7±3.3
р1<0.01

24.5±1.1 3.82±0.17 8.0±0.3
р1<0.01
р2<0.01

58.9±2.8 33.1±1.5

Systemic lupus 
erythematosus,
n=10 

69.2±3.3
р1<0.01

29.7±1.4 1.13±0.04 7.5±0.3
р1<0.01
р2<0.01

43.2±2.0 49.3±2.4

Notes:
p1 – statistically significant difference between the normal range and the number of normal-sized capillaries (8-12 μm) in the 
patients of both groups;
p2 – statistically significant difference between the number of capillaries 8-12 μm in diameter in the patients of the groups1 
and 2.

Figure 1. Biopsy material of skin flaps harvested from 
the finger of the patient F. with rheumatoid arthritis, 
medical record of the in-patient patient No. 01/10064. 
Staining H&E. ×600

Figure 2. Biopsy material of skin flaps harvested from 
the finger of the patient Sh. with systemic lupus 
erythematosus, medical record of the in-patient 
patient No. 01/00920. Staining H&E. ×600

Figure 3. Biopsy material of skin flaps harvested from 
the finger of the patient Kh. with systemic sclerosis, 
medical record of the in-patient patient No. 01/07587. 
Staining H&E. ×600

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In the rheograms of the patients with peri-
pheral blood circulation disorders the height of 
percussion wave and RI decrease is related to 
the increase in duration of the disease. Thus, 
RI in the forearms of the patients, who suffer 
from the disease for a period of less than 1 year, 
decreased by 19.07%. At the same time, the 
systolic blood flow in the forearms of the pa­
tients, who suffer for 10 or more years, de-
creased by 44.08%. Meanwhile, DI value points 
to hypertonia of precapillary vessels in all 
investigated groups, but this indice is statistically 
lower (p<0,001) among the patients, who suffer 
for a period of less than 1 year, and increases 
if the duration of the disease is longer. 

In the patients divided by the nosological 
units, the lowest rates of systolic flow were 
observed in patients with SSc, meanwhile, RI 
decreased by 46.05%; the patients with RA and 
a deficit in RI, representing 41.45 %, were the 
second; consequently, the smallest changes in 
RI were found in the patients with SLE, whose 
systolic blood flow in forearms decreased by 
28.29 %. The tonus of precapillary vessels, which 
was significantly higher in the patients with SSc 
(p<0.001), was changed compare to the above-
mentioned data. 

Analysis of rheovasography indices in terms 
of the degrees of inflammatory process acti­
vity (which was determined by the erythro-
cyte sedimentation rate) revealed no statistically 
significant difference. However, at the highest 
degree of the inflammatory process activity DI 

was of the smallest value and significantly 
different (p<0.001) from the indices at the 1st 
and 2nd degrees of activity. 

Thus, the most significant peripheral blood 
circulation disorders were found in the patients 
with SSc (p<0.05); disorders of peripheral blood 
flow were exacerbated in case of lengthening 
of disease course. Hypertonia of peripheral 
vessels and decrease in systolic blood flow were 
reflected in flattening of a rheographic curve 
and rheographic index decrease. Hypertonia of 
arterioles and precapillary vessels was evident 
by high location of incisures in relation to the 
apex of the rheographic curve and a high DI 
value. 

The analysis of morphometric data revealed 
that the average density of capillaries per unit 
area statistically decreased only in the patients 
with peripheral blood flow disorders in cases 
of SLE and SSc. 

Along with the decrease in the number of 
normal-sized capillaries, dilated and mega ca-
pillaries were present. Meanwhile, their number 
was small in the patients without peripheral 
blood flow disorders and statistically significant 
in the patients with hemodynamic disorders. 
In terms of relative values, the number of 
pathologic capillaries was 66.7% in cases of RA, 
92.0% in cases of SSc and 91.5% in cases of SLE. 

The concentration of ЕТ­1 was significantly 
higher in the patients with peripheral blood 
flow disorders. To examine the changes in 
concentration of ET-1 in detail, all the patients 
with the signs of vascular bed damage were 
divided into three groups by the degree of 
the inflammatory process activity. The revealed 
changes were reflected in gradual increase in 
concentration of ЕТ­1 in case of a higher degree 
of inflammatory process activity, though there 
was no statistically significant difference 
between the indices. 

According to the results of our study it has 
been established that microcirculatory bed 
changes in the patient with SSc and SLE com-
plied with other literature regarding investi-
gation of non-invasive methods of studying of 
microcirculatory bloodstream such as nailfold 
videocapillaroscopy [5, 6, 7]. Minimal changes 
have been revealed in the patients with RA [5]. 

Conclusions
It should be noted that peripheral hemo-

dynamic disorders are followed by significant 
microcirculatory bloodstream disorders such 
as decrease in average density of hemocapillaries 
per unit area, decrease in the number of nor-

Table 5. Concentration of ЕТ1 in the patients 
with rheumatic diseases with/without 
peripheral blood circulation disorders 

Group of patients ЕТ1, pkg/ml
Donors, n=10 1.8±0.7 
Group 1, n=5 1.9±0.5

p1>0.05
Group 2 SLE, n=10 19.0±1.4

p1<0.001
p2<0.001

SSc, n=10 23.1±1.5
p1<0.001
p2<0.001

RA, n=10 18.9±1.4
p1<0.001
p2<0.001

Notes:
p1 – statistically significant difference between indices in pa-
tients and donors; 
p2 – statistically significant difference between indices in pa-
tients of the groups 1 and 2.
RA – rheumatoid arthritis; SSc – systemic sclerosis; SLE – sys-
temic lupus erythematosus.

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mal-sized capillaries, and increase in the 
number of dilated and megacapillaries. Mor-
pho metric changes are accompanied by endo-
thelial dysfunction with a high concentration of 
ЕТ­1. In terms of integral estimation extremely 
high level of changes is evidenced in the 
patients with SSc which complies with current 
understanding of this disease. 

However, some morphometric peculiarities 
were revealed in the patients without peripheral 
blood flow disorders: in cases of adequate 
density of hemocapillaries per unit area, there 
was a decrease in the number of normal-sized 
capillaries and presence of dilated and mega-
capillaries. The above-mentioned changes were 
not followed by endothelial dysfunction in 
relation to ЕТ1 indicator. Thus, normal rheova­
sography did not preclude the presence of 
microcirculation disorders since biopsy revealed 
deeper changes in microcirculatory bed. 

The further research should be focused on 
the search for non-invasive methods of stu-
dying microcirculatory bloodstream in the 
patients with rheumatic diseases, which is the 
main cause of the development of systematicity.

Acknowledgements: The authors are 
gratefully acknowledged to Mariana Karanevych 
(PhD in Philology, Associate Professor) with the 
help in translation of this article.

Funding
This research received no external funding.
Conflict of Interests
The authors declare no conflict of interest.
Author Contributions
Zarudna O.I. – conceptualization, data cu-

ration, formal analysis, investigation, writing – 
original draft and review & editing; Venher I.K. – 
conceptualization, data curation, validation, 
methodology; Dovbush A.V. – formal analysis, 
investigation, visualization, software.

системні захВорюВання сполучноЇ тканини:  
Фокус на мікроциркуляторне русло

О.І. Зарудна, І.К. Венгер, А.В. Довбуш 
ТЕРНОПІЛЬСЬКИЙ НАЦІОНАЛЬНИЙ МЕДИЧНИЙ УНІВЕРСИТЕТ ІМЕНІ І.Я. ГОРБАЧЕВСЬКОГО, ТЕРНОПІЛЬ, 

УКРАЇНА
 
Вступ. Прояви системних захворювань є надзвичайно різноманітними. Їх об’єднує наявність 

васкуліту/васкулопатії, що й зумовлює системність і приводить до розвитку стійких порушень функції 
органів і систем. При цьому мішенню, джерелом та причиною патологічного процесу є ендотелій.

Мета. Провести комплексне вивчення стану мікроциркуляторного русла у хворих на системний 
червоний вовчак (СЧВ), системну склеродермію (ССД) та ревматоїдний артрит (РА). 

Методи. Для досягнення мети проведено ретроспективний аналіз архівних історій хвороби 129 
хворих на ревматичні захворювання, з них 39 – з верифікованим діагнозом ССД, 54 – СЧВ та 45 – РА. 
Переглянуто архів біоптатів шкірного клаптя пальця пацієнтів, на основі чого проведено 
морфометричний аналіз. Стан периферичної гемодинаміки вивчали за результатами поздовжньої 
реовазографії передпліч та гомілок. Вміст ЕТ - 1 визначено за імуноферментною методикою, яка 
ґрунтується на принципі конкурентного імуноферментного аналізу. Клінічні та лабораторні дані 
співставлень з результатами морфологічного дослідження біоптатів.

Результати. У переважної більшості пацієнтів виявлено розлади периферичної гемодинаміки. 
Встановлено, що ураження нирок, легень, серця частіше спостерігається у хворих з розладами 
периферичного кровоплину, проте найглибші порушення виявлено у хворих на системну склеродермію 
(p<0,05). Порушення периферичної гемодинаміки супроводжуються підвищенням концентрації 
ендотеліну-1 та поглиблюються за умови зростання тривалості хвороби. Кількість патологічних 
капілярів найвища у хворих на системну склеродермію. 

Висновки. Крайній ступінь розладів мікроциркуляторного русла за інтегральною оцінкою клініко-
лабораторних та морфометричних досліджень виявлено у пацієнтів на ССД. Однак знайдено деякі 
морфологічні особливості у пацієнтів без розладів периферичного кровоплину. Отже відсутність 
патологічних відхилень за результатами реовазографії не виключає розладів на мікроциркуляторному 
рівні. 

КЛЮЧОВІ СЛОВА: мікроциркуляція; системний червоний вовчак (СЧВ), системна 
склеродермія (ССД), ревматоїдний артрит (РА); біопсія; реовазографія.

O.I. Zarudna et al.



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ISSN 2413-6077. IJmmR 2019 Vol. 5 Issue 2

Інформація про авторів 
Зарудна Ольга Ігорівна – канд. мед. наук, доцент кафедри клінічної імунології, алергології та 

загального догляду за хворими, Тернопільський національний медичний університет імені І.Я. Гор­
бачевського.

Венгер Ігор Касянович – доктор медичних наук, професор, завідувач кафедри хірургії №2, 
Тернопільський національний медичний університет імені І.Я. Горбачевського.

Довбуш Андрій Васильович – канд. біол. наук, доцент кафедри гістології та ембріології, 
Тернопільський національний медичний університет імені І.Я. Горбачевського.

Information about the authors
Olga I. Zarudna – MD, Ph.D., Associate Professor, Department of Clinical Immunology, Allergology 

and General Patients′ Care, I. Horbachevsky Ternopil National Medical University. 
ORCID 0000­0002­9374­3991, e­mail: zarudna@tdmu.edu.ua 
Ihor K. Venher – MD, Ph.D., DSc, Professor, Head of the Department of Surgery No. 2, I. Horbachevsky 

Ternopil National Medical University. 
ORCID 0000­0003­0170­1995, e­mail: vengerik@tdmu.edu.ua
Andriy V. Dovbush – Ph.D., Associate Professor, Department of Histology and Embryology, 

I. Horbachevsky Ternopil National Medical University. 
ORCID 0000­0003­2246­6218, e­mail: dovbush@tdmu.edu.ua

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Received 03 July 2019; revised 03 October 2019; 
accepted 23 October 2019.

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original work is properly cited.

O.I. Zarudna et al.