Wig Surabhi, Wilkinson Jack, Moore Tonia, Manning Joanne, Chevance Aurelie, Vail Andy, Herrick Ariane L
Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, Rheumatology Directorate, Salford Royal NHS Foundation Trust, Salford, UK and Institute of Public Health Epidemiology and Development, University of Bordeaux Segalen, Bordeaux, France.
Rheumatology (Oxford). 2014 Nov;53(11):2009-13. doi: 10.1093/rheumatology/keu227. Epub 2014 Jun 6.
Digital ischaemia, often progressing beyond RP to digital ulceration and sometimes even gangrene, is the most common vascular manifestation of SSc. Both microvascular and macrovascular disease can contribute and coexistence of microvascular and macrovascular (proximal vessel) disease in patients with SSc is potentially limb threatening. The aims of this study were to examine the change over time in the ankle brachial pressure index (ABPI) in a cohort of patients with SSc and to examine whether age, gender, smoking status, disease duration, disease subtype and ACA are associated with ABPI.
The clinical and laboratory data of 217 patients attending the SSc clinic at a tertiary referral centre and who had their ABPIs checked between 1996 and 2011 were reviewed retrospectively. Data were analysed to see how the ABPI changed with time and linear mixed effects modelling was used to determine which factors were associated with ABPI.
In most patients with SSc, the ABPI remained constant over time [median rate of change 0 units/year, interquartile range (IQR) -0.01-0.01]. There was a significant association between lower ABPI and increasing age (P = 0.04), the limited cutaneous subtype of SSc (P = 0.01) and ACA positivity (P = 0.03). Additionally there was an association between ABPI and smoking status of borderline statistical significance (P = 0.08).
This study provides further evidence for associations between the severity of vascular disease in patients with SSc and increasing age, smoking, limited cutaneous disease and positive ACA. Reassuringly, in most patients ABPI remains stable over time.
指端缺血是系统性硬化症（SSc）最常见的血管表现，常从雷诺现象（RP）进展为指端溃疡，有时甚至发展为坏疽。微血管和大血管疾病均可导致指端缺血，SSc患者微血管和大血管（近端血管）疾病并存可能会威胁肢体。本研究旨在观察一组SSc患者的踝臂指数（ABPI）随时间的变化，并探讨年龄、性别、吸烟状况、病程、疾病亚型和抗着丝点抗体（ACA）是否与ABPI相关。
回顾性分析了217例在三级转诊中心SSc门诊就诊且于1996年至2011年间接受ABPI检查的患者的临床和实验室数据。分析数据以观察ABPI如何随时间变化，并使用线性混合效应模型确定哪些因素与ABPI相关。
在大多数SSc患者中，ABPI随时间保持稳定[变化中位数速率为0单位/年，四分位间距（IQR）为-0.01至0.01]。较低的ABPI与年龄增加（P = 0.04）、SSc的局限性皮肤亚型（P = 0.01）和ACA阳性（P = 0.03）之间存在显著关联。此外，ABPI与吸烟状况之间存在边缘统计学意义的关联（P = 0.08）。
本研究进一步证明了SSc患者血管疾病严重程度与年龄增加、吸烟、局限性皮肤疾病和ACA阳性之间的关联。令人欣慰的是，大多数患者的ABPI随时间保持稳定。
