Caramaschi Paola, Martinelli Nicola, Volpe Alessandro, Pieropan Sara, Tinazzi Ilaria, Patuzzo Giuseppe, Mahamid Helal, Bambara Lisa Maria, Biasi Domenico
Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Policlinico G.B. Rossi, Piazzale Scuro, 37134, Verona, Italy.
Clin Rheumatol. 2009 Jul;28(7):807-13. doi: 10.1007/s10067-009-1155-6. Epub 2009 Mar 20.
A single series of patients affected by systemic sclerosis (SSc) and cyclically treated with iloprost was reviewed in order to evaluate the incidence of digital ulcers (DUs) and to compare the characteristics between the patients with and without this painful and disabling vascular complication. The record charts of 85 SSc patients were revised. Ischemic DUs and scleroderma contracture ulcers were separately considered. Twenty-nine subjects developed ischemic DUs during the course of the disease; whereas, scleroderma contracture ulcers occurred in six subjects. Ischemic DUs were associated with younger age at scleroderma onset, a longer disease duration, a longer time delay from scleroderma diagnosis to iloprost therapy, a bigger skin involvement, the presence of joint contractures, a videocapillaroscopic late pattern, a history of smoking, and of corticosteroids therapy. After the exclusion of four subjects with concomitant peripheral arterial disease, a forward-stepwise logistic regression analysis showed that only four variables, i.e., age at scleroderma onset, delay in beginning iloprost therapy, history of smoking, and presence of joint contractures remained significantly associated with ischemic DUs. In a score reflecting the sum of these four risk factors, the prevalence of ischemic DUs increased progressively from the lowest to the highest value of the score. The predictivity of this model was evaluated by the receiver-operating characteristics curve, with an estimated area under the curve of 0.836 with 95% confidence interval from 0.736 to 0.937. All the patients with scleroderma contracture ulcers were characterized by both diffuse pattern of disease and positivity for anti-Scl70 antibody. In this retrospective study, scleroderma patients with ischemic DUs are characterized by early disease onset, delay in beginning iloprost therapy, smoking habit, and presence of joint contraction. A score reflecting the sum of these factors may be useful to predict the risk of developing ischemic DUs.
对一组系统性硬化症（SSc）患者进行回顾，这些患者接受了伊洛前列素的周期性治疗，以评估指端溃疡（DUs）的发生率，并比较有或无这种疼痛且致残的血管并发症患者的特征。对85例SSc患者的病历进行了复查。缺血性指端溃疡和硬皮病挛缩性溃疡分别进行了考虑。29名受试者在疾病过程中出现了缺血性指端溃疡；而硬皮病挛缩性溃疡发生在6名受试者中。缺血性指端溃疡与硬皮病发病时年龄较轻、病程较长、从硬皮病诊断到伊洛前列素治疗的时间延迟较长、皮肤受累范围较大、关节挛缩的存在、视频毛细血管镜检查的晚期模式、吸烟史以及皮质类固醇治疗史有关。在排除4例伴有外周动脉疾病的受试者后，向前逐步逻辑回归分析显示，只有4个变量，即硬皮病发病时的年龄、开始伊洛前列素治疗的延迟、吸烟史和关节挛缩的存在，仍与缺血性指端溃疡显著相关。在反映这4个危险因素总和的评分中，缺血性指端溃疡的患病率从评分的最低值到最高值逐渐增加。通过受试者工作特征曲线评估该模型的预测性，曲线下面积估计值为0.836，95%置信区间为0.736至0.937。所有患有硬皮病挛缩性溃疡的患者均具有疾病的弥漫性模式和抗Scl70抗体阳性的特征。在这项回顾性研究中，患有缺血性指端溃疡的硬皮病患者的特征为疾病发病早、开始伊洛前列素治疗延迟、吸烟习惯和关节挛缩的存在。反映这些因素总和的评分可能有助于预测发生缺血性指端溃疡的风险。
