Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, BE-9000 Gent, Belgium.
Arthritis Res Ther. 2011 Feb 28;13(1):R35. doi: 10.1186/ar3267.
The aims of the present study were to identify histopathological parameters which are linked to local clinical skin disease at two distinct anatomical sites in systemic sclerosis (SSc) patients with skin involvement (limited cutaneous systemic sclerosis (lcSSc) or diffuse cutaneous systemic sclerosis (dcSSc)) and to determine the sensitivity of SSc specific histological alterations, focusing on SSc patients without clinical skin involvement (limited SSc (lSSc)).
Histopathological alterations were systematically scored in skin biopsies of 53 consecutive SSc patients (dorsal forearm and upper inner arm) and 18 controls (upper inner arm). Clinical skin involvement was evaluated using the modified Rodnan skin score. In patients with lcSSc or dcSSc, associations of histopathological parameters with local clinical skin involvement were determined by generalised estimation equation modelling.
The hyalinised collagen score, the myofibroblast score, the mean epidermal thickness, the mononuclear cellular infiltration and the frequency of focal exocytosis differed significantly between biopsies with and without local clinical skin involvement. Except for mononuclear cellular infiltration, all of the continuous parameters correlated with the local clinical skin score at the dorsal forearm. Parakeratosis, myofibroblasts and intima proliferation were present in a minority of the SSc biopsies, but not in controls. No differences were found between lSSc and controls.
Several histopathological parameters are linked to local clinical skin disease. SSc-specific histological alterations have a low diagnostic sensitivity.
本研究旨在确定与系统性硬化症（SSc）患者皮肤受累（局限性皮肤型 SSc（lcSSc）或弥漫性皮肤型 SSc（dcSSc））两个不同解剖部位的局部临床皮肤疾病相关的组织病理学参数，并确定 SSc 特异性组织学改变的敏感性，重点关注无临床皮肤受累的 SSc 患者（局限性 SSc（lSSc））。
对 53 例连续 SSc 患者（前臂背侧和上臂内侧）和 18 例对照者（上臂内侧）的皮肤活检标本进行组织病理学改变的系统评分。采用改良 Rodnan 皮肤评分评估皮肤受累的临床情况。在 lcSSc 或 dcSSc 患者中，采用广义估计方程模型确定组织病理学参数与局部临床皮肤受累的相关性。
有和无局部临床皮肤受累的活检标本之间的胶原纤维透明化评分、肌成纤维细胞评分、平均表皮厚度、单核细胞浸润和局灶性胞吐的频率存在显著差异。除单核细胞浸润外，所有连续参数均与前臂背侧的局部临床皮肤评分相关。角化过度、肌成纤维细胞和内膜增生在少数 SSc 活检标本中存在，但在对照组中不存在。lSSc 与对照组之间无差异。
一些组织病理学参数与局部临床皮肤疾病相关。SSc 特异性组织学改变的诊断敏感性较低。
