Hackensack University Medical Center, Hackensack, New Jersey, USA.
Arthritis Care Res (Hoboken). 2011 May;63(5):735-42. doi: 10.1002/acr.20407.
To evaluate the construct validity of 2 proposed measures (the Ultrasound Disease Activity [U-DA] and the Tissue Thickness Score [TTS]) for evaluating sonographic differences in juvenile localized scleroderma skin lesions.
We conducted a retrospective review of juvenile localized scleroderma patients who had ultrasound scans of their skin lesions between October 2005 and February 2009. Imaged lesions were classified as active or inactive based upon clinical assessment. Lesions had to have been imaged within 1 month of a clinic visit or have the same clinical assessment during both the visit before and the visit after the scan. Two physicians scored the scans using the U-DA, which scores for differences in lesion echogenicity and vascularity compared with normal tissue. Tissue thickness differences were evaluated by percent differences and by using the TTS. Wilcoxon's rank sum test was performed to assess differences.
We studied 52 scans from 21 patients, 32 scans of active skin lesions and 20 scans of inactive skin lesions. Features reported by clinicians as indicative of active disease included erythema, warmth, violaceous color, new lesion, expansion of lesion, and induration. The U-DA was significantly different between active and inactive skin lesions (P = 0.0010) with significant differences found for the parameters of total echogenicity, hypodermis echogenicity, and deep tissue layer vascularity (P = 0.0014, P = 0.0023, and P = 0.0374, respectively). No significant differences were found for tissue layer thickness or TTS.
The U-DA may be a useful tool in the identification of localized scleroderma activity. Further study is needed to prospectively evaluate the validity, reliability, and sensitivity of this potential monitoring tool.
评估 2 种用于评估青少年局限性硬皮病皮肤病变超声差异的拟议指标（超声疾病活动度[U-DA]和组织厚度评分[TTS]）的结构效度。
我们对 2005 年 10 月至 2009 年 2 月期间进行皮肤超声检查的青少年局限性硬皮病患者进行了回顾性研究。根据临床评估将成像病变分为活动期或非活动期。病变必须在就诊前 1 个月内进行成像，或在扫描前后的就诊中具有相同的临床评估。两名医生使用 U-DA 对扫描结果进行评分，该评分比较病变与正常组织的回声和血管差异。通过百分比差异和 TTS 评估组织厚度差异。采用 Wilcoxon 秩和检验评估差异。
我们研究了 21 名患者的 52 次扫描，其中 32 次为活动期皮肤病变，20 次为非活动期皮肤病变。临床医生报告的提示疾病活动的特征包括红斑、发热、紫红色、新病变、病变扩大和硬结。U-DA 在活动期和非活动期皮肤病变之间存在显著差异（P = 0.0010），在总回声、皮下组织回声和深部组织层血管化方面差异显著（P = 0.0014、P = 0.0023 和 P = 0.0374）。在组织层厚度或 TTS 方面未发现显著差异。
U-DA 可能是识别局限性硬皮病活动的有用工具。需要进一步的前瞻性研究来评估这种潜在监测工具的有效性、可靠性和敏感性。
