CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET), Rennes, France.
University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France, Lille, France.
Arthritis Rheumatol. 2019 Jun;71(6):983-990. doi: 10.1002/art.40799. Epub 2019 Apr 29.
To evaluate the association of ulnar artery occlusion (UAO) assessed using Doppler ultrasound (DUS) with the severity markers of systemic sclerosis (SSc).
Two hundred four unselected patients fulfilling the American College of Rheumatology/European League Against Rheumatism 2013 classification criteria for SSc were included in this cross-sectional multicenter study. All patients underwent bilateral hand DUS to evaluate the presence of UAO and clinical/paraclinical visceral evaluation according to current guidelines. Univariable and multivariable ordinal regression models were applied, grading the severity of UAO as "no UAO," "only one UAO," and "UAO on both hands," and assessing its association with clinical features of SSc. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
UAO was found in 76 patients (37.3%) and was bilateral in 49 patients (24%). UAO as an ordinal event was significantly associated with disease duration, history of fingertip ulcers, telangiectasia, higher modified Rodnan skin thickness score (MRSS), worse diffusing capacity for carbon monoxide (DLco) values, higher tricuspid jet velocity, late capillaroscopic pattern, and positivity for anticentromere antibodies (ACAs) (univariable analysis). In the adjusted multivariable ordinal model, UAO was less frequent in women (OR 0.35 [95% CI 0.15-0.83], P = 0.017) and in patients receiving steroids (OR 0.24 [95% CI 0.09-0.62], P = 0.0034). In multivariable analyses, significant association with UAO was retained for history of fingertip ulcers (OR 2.55 [95% CI 1.24-5.21], P = 0.011), higher MRSS (OR 1.65 [95% CI 1.06-2.56], P =0.025), lower DLco values (OR 0.85 [95% CI 0.78-0.94], P = 0.0015), and ACA positivity (OR 2.89 [95% CI 1.36-6.11], P = 0.0056).
UAO may represent a relevant severity marker of vasculopathy in SSc. Its predictive value for the onset of severe vascular manifestations such as pulmonary arterial hypertension, and its association with mortality, remain to be determined in longitudinal studies.
评估使用多普勒超声（DUS）评估的尺动脉闭塞（UAO）与系统性硬化症（SSc）的系统性严重程度标志物的相关性。
本横断面多中心研究纳入了 204 例符合美国风湿病学会/欧洲抗风湿病联盟 2013 年 SSc 分类标准的未选择患者。所有患者均接受双侧手部 DUS 评估，以评估 UAO 的存在情况，并根据现行指南进行临床/实验室内脏评估。采用单变量和多变量有序回归模型，将 UAO 的严重程度分级为“无 UAO”、“仅一侧 UAO”和“双手 UAO”，并评估其与 SSc 临床特征的相关性。计算比值比（ORs）和 95%置信区间（95%CI）。
76 例（37.3%）患者存在 UAO，49 例（24%）患者为双侧 UAO。UAO 作为有序事件与疾病持续时间、指尖溃疡史、毛细血管扩张、改良 Rodnan 皮肤厚度评分（MRSS）更高、一氧化碳弥散量（DLco）值更差、三尖瓣射流速度更高、晚期毛细血管镜模式和抗着丝粒抗体（ACAs）阳性（单变量分析）显著相关。在调整后的多变量有序模型中，女性 UAO 发生率较低（OR 0.35 [95%CI 0.15-0.83]，P=0.017），接受皮质类固醇治疗的患者 UAO 发生率也较低（OR 0.24 [95%CI 0.09-0.62]，P=0.0034）。多变量分析中，指尖溃疡史（OR 2.55 [95%CI 1.24-5.21]，P=0.011）、MRSS 更高（OR 1.65 [95%CI 1.06-2.56]，P=0.025）、DLco 值更低（OR 0.85 [95%CI 0.78-0.94]，P=0.0015）和 ACA 阳性（OR 2.89 [95%CI 1.36-6.11]，P=0.0056）与 UAO 仍显著相关。
UAO 可能是 SSc 血管病变的一个重要严重程度标志物。其对肺动脉高压等严重血管表现的预测价值，以及与死亡率的相关性，仍需在纵向研究中确定。
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