Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
Nat Rev Rheumatol. 2010 Jul;6(7):430-4. doi: 10.1038/nrrheum.2010.65. Epub 2010 Jun 1.
The prognosis for patients with systemic sclerosis (SSc) has improved in the past three decades, with fewer patients succumbing to renal-crisis-related death. While pulmonary fibrosis and hypertension are currently the most frequent causes of death, there is evidence that cardiovascular disease will have an important role in the long-term prognosis of SSc in the future. Ischemia-reperfusion injury and endothelial dysfunction are cardinal features of SSc, and may predispose a patient to microvascular disease and atherosclerosis. In order to alleviate the cardiovascular burden in patients with SSc, it is important to detect endothelial dysfunction, microvascular flow disturbance and atherosclerosis. Noninvasive techniques that evaluate flow-mediated dilatation and arterial pulse waves (endothelial function measurements), microvascular blood flow (measurement of the microcirculation), carotid intima-media thickness and left ventricular hypertrophy (detection of atherosclerosis) are recommended. In addition, these measurements will facilitate trials of therapeutic strategies that, in addition to controlling conventional risk factors, prevent and treat cardiovascular disease in patients with SSc.
在过去的三十年中，系统性硬化症（SSc）患者的预后有所改善，死于肾危象相关死亡的患者减少。虽然肺纤维化和高血压目前是最常见的死亡原因，但有证据表明，心血管疾病将在 SSc 的长期预后中发挥重要作用。缺血再灌注损伤和内皮功能障碍是 SSc 的主要特征，可能使患者易患微血管疾病和动脉粥样硬化。为了减轻 SSc 患者的心血管负担，检测内皮功能障碍、微血管血流紊乱和动脉粥样硬化非常重要。建议使用评估血流介导的扩张和动脉脉搏波（内皮功能测量）、微血管血流（微循环测量）、颈动脉内膜中层厚度和左心室肥厚（动脉粥样硬化检测）的非侵入性技术。此外，这些测量将有助于进行治疗策略的试验，这些策略除了控制传统的危险因素外，还可以预防和治疗 SSc 患者的心血管疾病。
