CHU Rennes, University of Rennes, and UMR INSERM U1085, Research Institute in Health, Environment, and Occupation, Rennes, France.
CHU Rennes, University of Rennes, and UMR INSERM U991, Rennes, France.
Arthritis Care Res (Hoboken). 2018 Jun;70(6):938-943. doi: 10.1002/acr.23413. Epub 2018 Apr 12.
To compare microvascular damages on nailfold capillaroscopy (NFC) with macrovascular manifestations evaluated by hand power Doppler ultrasonography (PDUS) in systemic sclerosis (SSc) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers, acroosteolysis, and calcinosis.
NFC, hand radiographs, and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were performed blinded for the results of radiographs and NFC.
UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NFC (odds ratio [OR] 4.04 [95% confidence interval (95% CI) 1.23-13.29]; P < 0.05, and OR 3.38 [95% CI 1.03-11.05]; P < 0.05, respectively). Digital ulcer history was associated with UAO (OR 10.71 [95% CI 3.36-34.13]; P < 0.0001), pathologic FPBF (OR 7.67 [95% CI 2.52-23.28]; P < 0.0001), late NFC pattern (OR 6.33 [95% CI 2.03-19.68]; P = 0.001), and severe capillary loss (OR 8.52 [95% CI 2.15-33.78]; P = 0.001). Acroosteolysis was also associated with UAO (OR 15.83 [95% CI 3.95-63.54]; P < 0.0001), pathologic FPBF (OR 5.52 [95% CI 1.71-17.90]; P = 0.003), late NFC pattern (OR 6.86 [95% CI 2.18-21.53]; P = 0.001), and severe capillary loss (OR 7.20 [95% CI 2.16-24.02]; P = 0.001). Calcinosis on radiographs was associated with late NFC pattern (OR 5.41 [95% CI 1.82-16.12]; P = 0.002), severe capillary loss (OR 12.69 [95% CI 3.14-51.26]; P < 0.0001), and UAO (OR 3.19 [95% CI 1.14-8.92]; P = 0.025). Combination of UAO and severe capillary loss in the same patient was especially associated with digital ulcer history (OR 18.60 [95% CI 2.24-154.34]; P = 0.001) and acroosteolysis (OR 10.83 [95% CI 2.56-45.88]; P = 0.001).
Microvascular damages evaluated by NFC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease.
比较系统性硬化症（SSc）患者的甲襞毛细血管镜（NFC）微血管损伤与手部功率多普勒超声（PDUS）评估的大血管表现，并评估这些损伤与疾病主要手指表现（如溃疡、肢端骨质溶解和钙化）之间的相关性。
对 64 例未选择的 SSc 患者进行了 NFC、手部 X 线片和 PDUS 的系统评估。对桡动脉阻塞（UAO）和指垫血流（FPBF）进行 PDUS 评估，结果对 X 线片和 NFC 的结果进行了盲法评估。
UAO 和病理性 FPBF 与 NFC 严重毛细血管缺失（<4 个毛细血管/mm）相关（优势比[OR] 4.04 [95%置信区间（95%CI）1.23-13.29]；P < 0.05，和 OR 3.38 [95%CI 1.03-11.05]；P < 0.05）。溃疡病史与 UAO（OR 10.71 [95%CI 3.36-34.13]；P < 0.0001）、病理性 FPBF（OR 7.67 [95%CI 2.52-23.28]；P < 0.0001）、晚期 NFC 模式（OR 6.33 [95%CI 2.03-19.68]；P = 0.001）和严重毛细血管缺失（OR 8.52 [95%CI 2.15-33.78]；P = 0.001）相关。肢端骨质溶解也与 UAO 相关（OR 15.83 [95%CI 3.95-63.54]；P < 0.0001）、病理性 FPBF（OR 5.52 [95%CI 1.71-17.90]；P = 0.003）、晚期 NFC 模式（OR 6.86 [95%CI 2.18-21.53]；P = 0.001）和严重毛细血管缺失（OR 7.20 [95%CI 2.16-24.02]；P = 0.001）相关。X 线片上的钙化与晚期 NFC 模式相关（OR 5.41 [95%CI 1.82-16.12]；P = 0.002）、严重毛细血管缺失（OR 12.69 [95%CI 3.14-51.26]；P < 0.0001）和 UAO（OR 3.19 [95%CI 1.14-8.92]；P = 0.025）相关。UAO 和严重毛细血管缺失同时存在于同一患者中，与溃疡病史（OR 18.60 [95%CI 2.24-154.34]；P = 0.001）和肢端骨质溶解（OR 10.83 [95%CI 2.56-45.88]；P = 0.001）的相关性尤为明显。
通过 NFC 评估的微血管损伤与通过 PDUS 评估的 UAO 等大血管特征与疾病的主要手指表现具有一致的相关性。
