Knight L R, Smeathers J E, Isdale A H, Helliwell P S
Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK.
Rheumatology (Oxford). 2001 Feb;40(2):128-32. doi: 10.1093/rheumatology/40.2.128.
The pace, progression and extent of the skin lesions in scleroderma may parallel the risk of new internal organ involvement and the progression of existing internal lesions. Accurate assessment of cutaneous change permits an evaluation of patient prognosis and the response to therapy. The aim of this study was to assess a simple device for measuring skin stiffness for its ability to measure sclerodermatous skin in a quantitative and reproducible manner. Materials and methods. Torsional skin stiffness was measured in 56 normal subjects and 42 scleroderma patients (31 of whom had the limited form and nine the diffuse form, and two had mixed connective tissue disease). Data for the scleroderma patients were compared with data obtained by the use of the modified Rodnan clinical skin scoring technique. Intraclass correlation coefficients (ICCs) were calculated as a measure of intraobserver and interobserver variability.
For the left and right hands respectively, the ICCs for intraobserver variability were 0.908 and 0.906 and those for interobserver variability were 0.871 and 0.628. There was a significant difference in mean angular rotation obtained by normal subjects compared with scleroderma patients (15.1 vs 11.3 degrees, P<0.001). There was a significant difference in the angular rotation with increasing severity of skin involvement (skin score 0, median rotation 16.3 degrees; score 1, 10.5 degrees; score 2, 8.5 degrees; score 3, 8.0 degrees; P<0.00001).
The measurements obtained with the skin stiffness device are highly reproducible and are consistent with the current clinical method of assessment of skin involvement. The significant difference in angular rotation obtained by normal subjects and scleroderma patients indicates that the device can distinguish normal from sclerodermatous skin. The torsional stiffness measurements derived from the device may also be useful in longitudinal studies.
硬皮病皮肤病变的速度、进展和程度可能与新的内脏器官受累风险及现有内脏病变的进展情况平行。准确评估皮肤变化有助于评估患者预后及对治疗的反应。本研究的目的是评估一种用于测量皮肤硬度的简单装置，看其能否以定量且可重复的方式测量硬皮病皮肤。材料与方法。对56名正常受试者和42名硬皮病患者（其中31例为局限性硬皮病，9例为弥漫性硬皮病，2例为混合性结缔组织病）测量了扭转皮肤硬度。将硬皮病患者的数据与使用改良的罗德南临床皮肤评分技术获得的数据进行比较。计算组内相关系数（ICC）以衡量观察者内和观察者间的变异性。
左右手的观察者内变异性ICC分别为0.908和0.906，观察者间变异性ICC分别为0.871和0.628。正常受试者与硬皮病患者获得的平均角旋转存在显著差异（15.1度对11.3度，P<0.001）。随着皮肤受累严重程度增加，角旋转存在显著差异（皮肤评分为0时，中位旋转16.3度；评分为1时，10.5度；评分为2时，8.5度；评分为3时，8.0度；P<0.00001）。
用皮肤硬度装置获得的测量结果具有高度可重复性，且与目前评估皮肤受累的临床方法一致。正常受试者和硬皮病患者获得的角旋转显著差异表明该装置能区分正常皮肤和硬皮病皮肤。该装置得出的扭转硬度测量结果在纵向研究中可能也有用。
