Chen Chen, Cheng Yi, Zhu Xiaoxia, Cai Yehua, Xue Yu, Kong Ning, Yu Yiyun, Xuan Dandan, Zheng Shucong, Yang Xue, Zhu Zaihua, Zhao Tianyi, Wan Weiguo, Zou Hejian, Liang Minrui
Division of Rheumatology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China.
Arthritis Res Ther. 2020 Aug 26;22(1):197. doi: 10.1186/s13075-020-02285-x.
Ultrasound is a useful tool to evaluate and quantify skin lesions. Few studies have assessed the criterion validity of skin ultrasound in systemic sclerosis (SSc). The aims of the study were to investigate skin thickness and stiffness using ultrasound and shear wave elastography (SWE) in SSc and to validate skin ultrasound measurements against histological skin thickness.
A total of 22 patients with diffuse cutaneous SSc (dcSSc), 22 with limited cutaneous SSc (lcSSc), and 22 age- and gender-matched healthy controls were enrolled. Skin thickness and stiffness were measured by B-mode ultrasound with SWE imaging on the bilateral fingers and hands. Additional ultrasound evaluation was carried out in 13 patients (9 dcSSc and 4 lcSSc) on their dorsal forearms, followed by skin biopsy conducted in the same skin areas. Correlations between ultrasound measurements and histological skin thickness and modified Rodnan skin score (mRSS) were investigated using Spearman's correlation.
Compared with controls, ultrasound-measured skin thickness and skin stiffness were significantly higher in patients with SSc (p < 0.001) and even higher in those with dcSSc. No clear correlation could be established between ultrasound-determined skin thickness and stiffness at the same site. Ultrasound-measured skin thickness correlated well with histological skin thickness (r = 0.6926, p = 0.009). A weaker association was also observed between histological skin thickness and local mRSS (r = 0.5867, p = 0.050).
Ultrasound is a reliable tool for quantifying skin involvement in SSc. Ultrasound-measured skin thickness showed good agreement with histological skin thickness.
超声是评估和量化皮肤病变的有用工具。很少有研究评估皮肤超声在系统性硬化症（SSc）中的标准效度。本研究的目的是使用超声和剪切波弹性成像（SWE）研究SSc患者的皮肤厚度和硬度，并对照组织学皮肤厚度验证皮肤超声测量结果。
共纳入22例弥漫性皮肤型SSc（dcSSc）患者、22例局限性皮肤型SSc（lcSSc）患者以及22名年龄和性别匹配的健康对照者。通过B型超声和SWE成像测量双侧手指和手部的皮肤厚度和硬度。对13例患者（9例dcSSc和4例lcSSc）的前臂背侧进行了额外的超声评估，随后在相同皮肤区域进行皮肤活检。使用Spearman相关性研究超声测量结果与组织学皮肤厚度和改良Rodnan皮肤评分（mRSS）之间的相关性。
与对照组相比，SSc患者超声测量的皮肤厚度和皮肤硬度显著更高（p < 0.001），dcSSc患者更高。同一部位超声测定的皮肤厚度和硬度之间无法建立明确的相关性。超声测量的皮肤厚度与组织学皮肤厚度相关性良好（r = 0.6926，p = 0.009）。组织学皮肤厚度与局部mRSS之间也观察到较弱的相关性（r = 0.5867，p = 0.050）。
超声是量化SSc皮肤受累情况的可靠工具。超声测量的皮肤厚度与组织学皮肤厚度显示出良好的一致性。
