Allanore Y, Seror R, Chevrot A, Kahan A, Drapé J L
René Descartes University, and Service de Rheumatologie A, Hôpital Cochin, 27 Rue du Faubourg St. Jacques, 75014 Paris, France.
Arthritis Rheum. 2007 Aug;56(8):2747-54. doi: 10.1002/art.22734.
Impairment of the microcirculation is a cardinal feature of systemic sclerosis (SSc). Magnetic resonance angiography (MRA) has improved the assessment of vascular lesions of the hand. The aim of this study was to evaluate vascular abnormalities in the hands of patients with SSc, using MRA.
Thirty-eight patients with SSc were compared with 7 healthy subjects and 7 patients with rheumatoid arthritis. Among patients with SSc, the mean +/- SD age was 52 +/- 14 years, the mean +/- SD Health Assessment Questionnaire (HAQ) score was 0.9 +/- 0.8, and the mean +/- SD systolic pulmonary artery pressure (PAP) was 32.2 +/- 8.4 mm Hg. Ten patients had a history of digital ulcers. The MRA protocol consisted of 4 successive acquisitions, each lasting 52 seconds, of 3-dimensional coronal cross-sectional images after gadolinium injection. The primary criteria were distality and quality of arterial opacification, avascular areas, and venous return.
Thirty-five of the patients with SSc (92%) had at least 1 true digital artery that did not reach the first phalanx at the initial arterial analysis, and 23 patients (61%) had > or =4 damaged arteries. Twenty-eight patients (74%) had thin arteries, and 20 patients (53%) had >1 avascular area. Nearly all patients (35 of 38 [92%]) had abnormal venous return, and a lack of visible venous return was observed in 16 patients (42%). Results for all of the control subjects were considered normal. Digital ulcers were more frequently observed in patients with SSc who had > or =4 damaged proper digital arteries compared with other patients (P = 0.003), the HAQ score was associated with thin-caliber arteries (P = 0.04), and systolic PAP was associated with tissue enhancement secondary to ischemia (P = 0.04).
These results show the substantial vascular involvement in SSc. Lesions were diffuse and involved both arterial and venous vessels of small caliber as well as the microcirculation.
微循环障碍是系统性硬化症（SSc）的主要特征。磁共振血管造影（MRA）改善了对手部血管病变的评估。本研究旨在使用MRA评估SSc患者手部的血管异常情况。
将38例SSc患者与7名健康受试者及7例类风湿关节炎患者进行比较。在SSc患者中，平均年龄±标准差为52±14岁，平均健康评估问卷（HAQ）评分±标准差为0.9±0.8，平均收缩期肺动脉压（PAP）±标准差为32.2±8.4 mmHg。10例患者有指端溃疡病史。MRA方案包括在注射钆后连续采集4次，每次持续52秒的三维冠状面断层图像。主要标准为动脉显影的远端和质量、无血管区域及静脉回流情况。
在初始动脉分析时，35例（92%）SSc患者至少有1条真性指动脉未到达第一指骨，23例（61%）患者有≥4条受损动脉。28例（74%）患者动脉纤细，20例（53%）患者有>1个无血管区域。几乎所有患者（38例中的35例[92%]）静脉回流异常，16例（42%）患者观察到无可见静脉回流。所有对照受试者的结果均被认为正常。与其他患者相比，SSc患者中≥4条指固有动脉受损者更常出现指端溃疡（P = 0.003），HAQ评分与动脉管径变细相关（P = 0.04），收缩期PAP与缺血继发的组织强化相关（P = 0.04）。
这些结果表明SSc存在广泛的血管受累。病变是弥漫性的，累及小口径的动脉和静脉血管以及微循环。
