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甲襞毛细血管显微镜检查在鉴别原发性和继发性雷诺现象及预测系统性硬化症中的再评估:一项随机观察前瞻性队列研究。

Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud's phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study.

机构信息

Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.

UDIMS - Unidade de Doenças Imuno-Mediadas Sistémicas, Departamento de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Amadora, Portugal.

出版信息

Expert Rev Clin Immunol. 2024 Jun;20(6):665-672. doi: 10.1080/1744666X.2024.2313642. Epub 2024 Mar 11.

Abstract

BACKGROUND

Primary Raynaud's phenomenon (pRP) is difficult to distinguish from secondary (sRP). Although nailfold capillaroscopy (NFC) may detect early alterations, no universal criteria yet discriminate between pRP from sRP.

OBJECTIVES

To create and validate two NFC scores that could distinguish pRP from sRP and that could predict systemic sclerosis (SSc), respectively.

METHODS

We performed NFC on two separate cohorts with isolated RP, and recorded number of capillaries per field, enlarged/giant capillaries, crossed/bizarre patterns, microhemorrhages, neoangiogenesis, rarefaction, edema, blood flow velocity, stasis. By multivariate regression analysis, we evaluated the adjusted prognostic role of these features in a derivation cohort of 656 patients. Results were used to construct algorithm-based prognostic scores (A and B). These scores were then tested on a confirmation cohort of 219 patients.

RESULTS

Score A was unable to discriminate sRP from pRP (low negative predictive values with high positive predictive values for any cut-point); score B was unable to discriminate progression to SSc or a SSc-spectrum disorder (low positive predictive values with high negative predictive values for lower cut-points).

CONCLUSION

NFC patterns, believed as specific, showed low discriminatory power and on their own are unable to reliably discriminate sRP from pRP or predict evolution to SSc.

摘要

背景

原发性雷诺现象(pRP)与继发性(sRP)难以区分。虽然甲襞毛细血管镜(NFC)可能检测到早期改变,但尚无通用标准来区分 pRP 与 sRP。

目的

创建和验证两个 NFC 评分,分别用于区分 pRP 与 sRP,以及预测系统性硬化症(SSc)。

方法

我们对两个单独的孤立性 RP 队列进行了 NFC,并记录了每个视野的毛细血管数量、放大/巨大毛细血管、交叉/奇异模式、微出血、新血管生成、稀疏、水肿、血流速度、停滞。通过多变量回归分析,我们评估了这些特征在 656 例患者的推导队列中的调整预后作用。结果用于构建基于算法的预后评分(A 和 B)。然后在 219 例患者的确认队列中测试这些评分。

结果

评分 A 无法区分 sRP 与 pRP(任何切点的阴性预测值低而阳性预测值高);评分 B 无法区分进展为 SSc 或 SSc 谱障碍(较低切点的阳性预测值低而阴性预测值高)。

结论

被认为是特异性的 NFC 模式显示出低区分能力,并且单凭它们无法可靠地区分 sRP 与 pRP 或预测向 SSc 的演变。

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