Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Clin Rheumatol. 2020 Jan;39(1):69-75. doi: 10.1007/s10067-019-04662-7. Epub 2019 Jul 17.
Digital ulcers (DUs) represent one major burden for patients with systemic sclerosis (SSc). The objectives of our study were to evaluate blood flow in SSc-DUs with laser speckle contrast analysis (LASCA) and to correlate the skin perfusion to clinical and laboratory data.
Forty DUs in 31 consecutive patients with SSc according to 2013 ACR/EULAR criteria (20 with limited cutaneous disease, 3 males) were prospectively examined with LASCA. Clinical and laboratory data were collected at the same time. DUs were classified according to clinical features and presence of infection.
At LASCA analysis, patients with diffuse SSc had lower mean values of blood flow compared with those with limited disease at the finger affected by DUs (88.80 vs 44.40, p = 0.036) and at the periulcer area (p = 0.041). The presence of infection was associated to a higher flow at the finger with DU (103.02 vs 58.05 p = 0.04), at the level of ulcer (217.63 vs 67.15, p < 0.001), and at the periulcer area (p = 0.001). The ratio between the blood flow at the ulcer area and the finger base (UA/FB) showed a bimodal trend in patients with infected DUs and in those without infections. Infection was positive correlated to the time of healing (HT) (r = 0.648, p = 0.023), while in DUs without infection a negative correlation to HT (r = - 0.46, p = 0.015) was identified.
This study demonstrates for the first time that the UA/FB ratio may predict the healing time of DUs in SSc patients and may be crucial for the prognostic stratification of patients. Infection remains one of the main predictors of DU healing.Key Points• The prognostic value of laser speckle contrast analysis (LASCA) in patients with digital ulcers (DUs) in systemic sclerosis remains to be clarified.• LASCA may be able to predict the haling time of the digital ulcers.• The presence of infection of the wound bed may greatly influence the LASCA parameters and the healing time of the digital ulcer.
手指溃疡（DU）是系统性硬化症（SSc）患者的主要负担之一。本研究的目的是使用激光散斑对比分析（LASCA）评估 SSc-DU 的血流，并将皮肤灌注与临床和实验室数据相关联。
对 2013 年 ACR/EULAR 标准确诊的 31 例连续 SSc 患者的 40 个 DU （20 例局限性皮肤疾病，3 例男性）进行前瞻性 LASCA 检查。同时收集临床和实验室数据。根据临床特征和感染情况对 DU 进行分类。
在 LASCA 分析中，弥漫性 SSc 患者手指 DU 受累处（88.80 比 44.40，p = 0.036）和溃疡周围区域（p = 0.041）的血流均值明显低于局限性疾病患者。感染的存在与 DU 手指（103.02 比 58.05，p = 0.04）、溃疡处（217.63 比 67.15，p < 0.001）和溃疡周围区域（p = 0.001）的血流较高相关。感染 DU 和无感染 DU 的溃疡区与手指基底部（UA/FB）的血流比值呈双峰趋势。感染与愈合时间（HT）呈正相关（r = 0.648，p = 0.023），而无感染 DU 与 HT 呈负相关（r = -0.46，p = 0.015）。
本研究首次证明，UA/FB 比值可能预测 SSc 患者 DU 的愈合时间，对患者的预后分层至关重要。感染仍然是 DU 愈合的主要预测因素之一。
激光散斑对比分析（LASCA）在系统性硬化症患者手指溃疡（DU）中的预后价值尚不清楚。
LASCA 可能能够预测 DU 的愈合时间。
创面感染的存在可能会极大地影响 LASCA 参数和 DU 的愈合时间。
