Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Dermatology Department, APHP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, F-75010, Paris, France.
Clin Rheumatol. 2021 Sep;40(9):3679-3686. doi: 10.1007/s10067-021-05672-0. Epub 2021 Mar 6.
Systemic sclerosis (SSc) is a connective tissue disease characterized by microangiopathy. Peripheral arterial disease, increasingly studied during SSc, is responsible for digital ulcers, associated with a high risk of amputation. The aim of our study was to assess the frequency of lower limb arterial impairment in SSc patients by measuring ankle-brachial index (ABI), toe pressure (TP), and toe-brachial index (TBI).
Systemic sclerosis patients were included prospectively during 1 year in Tenon and Saint-Antoine Hospitals, Paris. Clinical and biological data were recorded. For each patient, ABI, TP, and TBI were measured and an arterial duplex ultrasonography was prescribed in case of abnormal results.
Eighty-six patients were included (94% women, median age 62 years). Only 24% of them had no lower limb hemodynamic vascular abnormalities; 44% had an isolated microvascular abnormality (normal ABI and TBI<0.75); 31% had at least a macrovascular injury associated or not with microvascular impairment (abnormal ABI) and 12.6% had a TP<50 mmHg. During follow-up, there was a trend towards association of low TBI with more major adverse event (all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and lower limb ischemic manifestations) than normal TBI.
By measuring ABI and TP, we showed that 76% of SSc patients had hemodynamic arterial lower limb abnormalities related to macro- and/or microvascular impairment and that 28% had vascular stiffness. In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying micro- and macrovascular changes. Key Points • The presence of lower limb macro-and/or microvascular involvement was detected in 76% of SSc patients. • In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying microvascular changes and frequent arterial stiffness.
系统性硬化症（SSc）是一种以微血管病变为特征的结缔组织疾病。周围动脉疾病在 SSc 中越来越受到研究，它会导致手指溃疡，这与高截肢风险相关。我们的研究旨在通过测量踝臂指数（ABI）、趾压（TP）和趾臂指数（TBI）来评估 SSc 患者下肢动脉损伤的频率。
在巴黎 Tenon 和 Saint-Antoine 医院，前瞻性地纳入了 1 年内的系统性硬化症患者。记录了临床和生物学数据。对于每位患者，测量了 ABI、TP 和 TBI，如果结果异常，则开具了动脉双功能超声检查。
共纳入 86 例患者（94%为女性，中位年龄 62 岁）。他们中仅有 24%无下肢血液动力学血管异常；44%存在孤立的微血管异常（ABI 和 TBI<0.75 正常）；31%至少存在与微血管损害相关或不相关的大血管损伤（ABI 异常），12.6%的患者 TP<50mmHg。在随访期间，低 TBI 与更多主要不良事件（全因死亡率、非致命性中风、非致命性心肌梗死和下肢缺血表现）相关，而 TBI 正常则无此趋势。
通过测量 ABI 和 TP，我们发现 76%的 SSc 患者存在与大血管和/或微血管损害相关的下肢血液动力学动脉异常，28%的患者存在血管僵硬。在 SSc 患者中，ABI 不是检测下肢动脉疾病的准确工具，可能是由于潜在的微血管和大血管变化所致。关键点：
SSc 患者存在下肢大血管和/或微血管受累。
在 SSc 患者中，ABI 不是检测下肢动脉疾病的准确工具，可能是由于潜在的微血管变化和频繁的动脉僵硬所致。
