系统性硬化症中的外周大血管受累：一项彩色和频谱多普勒超声队列研究
Peripheral Macrovascular Involvement in Systemic Sclerosis: A Cohort Study by Color and Spectral Doppler Ultrasonography.
作者信息
D'Alessandro Roberto, Garcia Gonzalez Estrella, Falsetti Paolo, Conticini Edoardo, d'Alessandro Miriana, Selvi Enrico, Bellisai Francesca, Berlengiero Virginia, Vallifuoco Giulia, Pata Anna Paola, Bardelli Marco, Baldi Caterina, Cantarini Luca, Bargagli Elena, Frediani Bruno
机构信息
Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
出版信息
Life (Basel). 2023 Feb 10;13(2):487. doi: 10.3390/life13020487.
OBJECTIVES
Systemic sclerosis (SSc) is a disease characterized by diffuse sclerosis of skin and organs and small vessel vasculopathy. Despite it, large vessels can also be involved with ulnar artery vasculopathy, revealing as a more frequent feature of SSc. The aim of this paper is to assess the macrovascular involvement of SSc patients through an ultrasound (US) evaluation of radial and ulnar arteries.
METHODS
Radial and ulnar resistance indices (RIs) and peak systolic velocity (PV) (cm/s) together with clinical features of SSc patients were evaluated. Raynaud phenomenon (RP) and healthy control (HC) groups were used for comparison.
RESULTS
Forty-three SSc patients were evaluated. Twelve patients (28%) had ulnar artery occlusions (UAOs). In nine cases (75%), UAOs were bilateral. A high UAO prevalence (42%) was found in SSc patients with late nailfold-video-capillaroscopy (NVC) pattern ( = 0.0264). Patients with UAOs had digital ulcers (DUs) in 10 cases (83.3%). Radial and ulnar PVs were lower in SSc and RP patients than the HC group. Radial and ulnar RIs were higher in SSc and RP patients than the HC group. A decision tree analysis led to the classification of 70% of SSc patients with an ulnar RI > 0.82 and ulnar PV > 2.8 cm/s. The most influential variables on UAO development were interstitial lung disease (ILD) ( = 0.002) and NVC pattern ( = 0.002). A positive correlation was shown between modified Rodnan skin score (mRSS) and ILD ( = 0.283; r = 0.033), mRSS and DU (r = 0.344; = 0.012) and DU and ILD (r = 0.303; = 0.024). Male sex was associated with increased UAO frequency ( = 0.042).
CONCLUSIONS
UAO is a peculiar feature of severe SSc present in 28% of the cases, particularly associated with the presence of ILD and late NVC pattern. In 75% of the cases, UAOs are bilateral. DUs are very frequent in patients with UAOs (83%). The RI evaluated by US could be useful to distinguish SSc from HC patients. US could be a useful tool for assessing high-risk DU development in patients.
目的
系统性硬化症（SSc）是一种以皮肤和器官弥漫性硬化以及小血管血管病变为特征的疾病。尽管如此，大血管也可能受累，出现尺动脉血管病变，这在SSc中是一种更常见的特征。本文旨在通过对桡动脉和尺动脉的超声（US）评估来评估SSc患者的大血管受累情况。
方法
评估了SSc患者的桡动脉和尺动脉阻力指数（RIs）、收缩期峰值流速（PV）（厘米/秒）以及临床特征。使用雷诺现象（RP）组和健康对照组（HC）进行比较。
结果
对43例SSc患者进行了评估。12例患者（28%）存在尺动脉闭塞（UAO）。其中9例（75%）为双侧UAO。在晚期甲襞视频毛细血管镜检查（NVC）模式的SSc患者中发现了较高的UAO患病率（42%）（P = 0.0264）。有UAO的患者中有10例（83.3%）出现指端溃疡（DU）。SSc患者和RP患者的桡动脉和尺动脉PV低于HC组。SSc患者和RP患者的桡动脉和尺动脉RIs高于HC组。决策树分析将70%的尺动脉RI>0.82且尺动脉PV>2.8厘米/秒的SSc患者进行了分类。对UAO发生影响最大的变量是间质性肺疾病（ILD）（P = 0.002）和NVC模式（P = 0.002）。改良Rodnan皮肤评分（mRSS）与ILD之间呈正相关（P = 0.283；r = 0.033），mRSS与DU之间呈正相关（r = 0.344；P = 0.012），DU与ILD之间呈正相关（r = 0.303；P = 0.024）。男性与UAO频率增加相关（P = 0.042）。
结论
UAO是严重SSc的一个特殊特征，在28%的病例中存在，尤其与ILD和晚期NVC模式有关。在75%的病例中，UAO是双侧的。有UAO的患者中DU非常常见（83%）。通过超声评估的RI可能有助于区分SSc患者和HC患者。超声可能是评估患者发生高危DU的有用工具。
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