Volikova Antonina I, Edwards Janice, Stacey Michael C, Wallace Hilary J
Fremantle Hospital, Fremantle, Western Australia, Australia.
J Vasc Surg. 2009 Oct;50(4):820-5. doi: 10.1016/j.jvs.2009.05.060. Epub 2009 Jul 22.
The purpose of this study was to validate high-frequency ultrasound (HFU) measurement of dermal thickness for quantification of edema in patients with different severities of chronic venous disease.
HFU measurements of dermal thickness were made with a 17-MHz probe (Philips iU22 Ultrasound scanner, Bothell, Wash) or a 20-MHz medium-focus probe (DermaScan-C, Cortex Technology, Denmark), 7.5 cm above the medial malleolus. For validation, 20 patients with venous leg ulcers who were not receiving compression therapy, 20 patients with previous deep vein thrombosis (DVT) and symptoms of post-thrombotic syndrome (PTS) without ulceration, and 31 age-matched healthy controls were measured on a single occasion. To investigate the effect of compression on dermal thickness, the leg ulcer patients from the validation study were treated with compression therapy for 7 weeks and measured after 1, 3, 5, and 7 weeks. The association between dermal thickness and the clinical (C) component of the CEAP classification was examined in a cross-sectional analysis of 157 patients with a confirmed history of DVT >or=3 years ago.
Dermal thickness in patients with venous leg ulcers before compression therapy (median, 2.56 mm; interquartile range [IQR], 2.31-2.82 mm) was significantly greater (P = .002) than that in patients with symptoms of PTS without ulceration (median, 2.16 mm; IQR, 1.90-2.36 mm). Dermal thickness in both groups was significantly greater (P < .0001) than the control group (median, 1.34 mm; IQR, 1.29-1.44 mm). Compression therapy caused a steady and significant decrease in dermal thickness during the first 5 weeks until normal control levels were achieved. Dermal thickness increased with increasing CEAP category. In 121 patients with a positive diagnosis of DVT >or=3 years ago from Radiology Department records, a hypothetical test cutoff of 1.985 mm for the prediction of severe PTS noted as C(4b), C(5), and C(6) (lipodermatosclerosis or leg ulceration) had a positive predictive value of 46.9% and a negative predictive value of 90.3%.
HFU measurement of dermal thickness enables the monitoring of edema reduction by compression therapy. A prospective study is required to determine the temporal dynamics of dermal thickness changes after DVT and the relationship to the development of PTS. This test has the potential to be beneficial in the follow-up of patients after a DVT and provide clinical evidence for using graduated elastic compression stockings to control edema and prevent the development of more advanced skin changes.
本研究的目的是验证高频超声（HFU）测量真皮厚度以量化不同严重程度慢性静脉疾病患者水肿情况的可行性。
使用17兆赫探头（飞利浦iU22超声扫描仪，华盛顿州博塞尔）或20兆赫中焦距探头（丹麦科特斯技术公司的DermaScan - C）在内踝上方7.5厘米处测量真皮厚度。为进行验证，对20例未接受加压治疗的下肢静脉溃疡患者、20例既往有深静脉血栓形成（DVT）且有血栓后综合征（PTS）症状但无溃疡的患者以及31例年龄匹配的健康对照者进行单次测量。为研究加压对真皮厚度的影响，对验证研究中的下肢溃疡患者进行7周的加压治疗，并在第1、3、5和7周后进行测量。在对157例确诊DVT病史≥3年的患者进行的横断面分析中，研究了真皮厚度与CEAP分类临床（C）成分之间的关联。
加压治疗前下肢静脉溃疡患者的真皮厚度（中位数为2.56毫米；四分位间距[IQR]为2.31 - 2.82毫米）显著大于（P = 0.002）无溃疡的PTS症状患者（中位数为2.16毫米；IQR为1.90 - 2.36毫米）。两组患者的真皮厚度均显著大于（P < 0.0001）对照组（中位数为1.34毫米；IQR为1.29 - 1.44毫米）。加压治疗在最初5周内使真皮厚度持续显著下降，直至达到正常对照水平。真皮厚度随CEAP类别增加而增加。在121例根据放射科记录确诊DVT病史≥3年的患者中，预测严重PTS（定义为C(4b)、C(5)和C(6) [脂肪皮肤硬化或下肢溃疡]）的假设测试临界值为1.985毫米，其阳性预测值为46.9%，阴性预测值为90.3%。
HFU测量真皮厚度能够监测加压治疗引起的水肿减轻情况。需要进行前瞻性研究以确定DVT后真皮厚度变化的时间动态以及与PTS发展的关系。该测试有可能对DVT后患者的随访有益，并为使用分级弹性加压袜控制水肿和预防更严重皮肤变化的发展提供临床证据。
