Weibel Lisa, Howell Kevin J, Visentin Maria Teresa, Rudiger Alain, Denton Christopher P, Zulian Francesco, Woo Patricia, Harper John I
Great Ormond Street Hospital for Children, London, UK.
Arthritis Rheum. 2007 Oct;56(10):3489-95. doi: 10.1002/art.22920.
Assessment of disease activity is a major challenge in the management of children with localized scleroderma. The aim of this study was to evaluate the role of laser Doppler flowmetry (LDF) in comparison with infrared thermography in the detection of scleroderma disease activity.
In 41 children with localized scleroderma, 111 lesions were assessed on 2 separate occasions, by clinical examination, LDF, and thermography. Measurements from contralateral areas of unaffected skin served as intrapatient controls, and differences in blood flow and temperature were calculated between the corresponding sites. The sensitivity and specificity to detect clinically active lesions were compared between LDF and thermography.
Seventy-five active lesions (34%) and 147 inactive lesions (66%) were identified clinically. The median relative increase in blood flow measured by LDF was +89% (range -69% to +449%) for clinically active lesions and +11% (range -46% to +302%) for clinically inactive lesions (P < 0.001). Thermography showed a median difference in temperature of +0.5 degrees C (range -0.1 degrees C to +4.1 degrees C) and +0.3 degrees C (range -1.9 degrees C to +2.7 degrees C) for clinically active lesions and clinically inactive lesions, respectively (P = 0.024). Using a cutoff level of 39% to indicate increase in blood flow, a sensitivity of 80% and specificity of 77% to detect clinically active lesions were observed; for thermography, no useful cutoff level was identified. The correlation between differences in blood flow and differences in temperature was small, but significant (r2 = 0.120, P < 0.001).
LDF is a helpful, noninvasive diagnostic technique that can be used to discriminate disease activity in children with localized scleroderma, and is more accurate than thermography for this purpose.
评估疾病活动度是局限性硬皮病患儿管理中的一项重大挑战。本研究的目的是评估激光多普勒血流仪（LDF）与红外热成像相比在检测硬皮病疾病活动度方面的作用。
对41例局限性硬皮病患儿的111处皮损在两个不同时间点进行评估，评估方法包括临床检查、LDF和热成像。未受影响皮肤的对侧区域测量值作为患者自身对照，并计算相应部位之间的血流和温度差异。比较LDF和热成像检测临床活动皮损的敏感性和特异性。
临床共识别出75处活动皮损（34%）和147处非活动皮损（66%）。LDF测量的临床活动皮损血流相对增加中位数为+89%（范围-69%至+449%），临床非活动皮损为+11%（范围-46%至+302%）（P<0.001）。热成像显示临床活动皮损和临床非活动皮损的温度中位数差异分别为+0.5℃（范围-0.1℃至+4.1℃）和+0.3℃（范围-1.9℃至+2.7℃）（P = 0.024）。使用血流增加39%的截断水平，检测临床活动皮损的敏感性为80%，特异性为77%；对于热成像，未确定有用的截断水平。血流差异与温度差异之间的相关性较小，但具有显著性（r2 = 0.120，P<0.001）。
LDF是一种有用的非侵入性诊断技术，可用于鉴别局限性硬皮病患儿的疾病活动度，且在此方面比热成像更准确。
