Enomoto D N, Mekkes J R, Bossuyt P M, Hoekzema R, Bos J D
Department of Dermatology, University of Amsterdam, The Netherlands.
J Am Acad Dermatol. 1996 Sep;35(3 Pt 1):381-7. doi: 10.1016/s0190-9622(96)90601-5.
The skin score, a subjective assessment of skin elasticity, is widely used in patients with systemic sclerosis. Although this scoring method is regarded as a validated and accepted tool, the interobserver and intraobserver reproducibility is relatively poor.
Our purpose was to investigate whether the recently developed SEM 474 cutometer, which exerts a controlled vacuum force to the skin, can measure skin elasticity more objectively than the skin score.
Skin elasticity was measured in 74 different body areas in patients with systemic sclerosis and compared with the skin score obtained from the same areas.
The cutometer produced quantitative and reproducible data. A large-diameter (8 mm) measuring probe was superior to a small probe. The interobserver intraclass correlation coefficient (ICC) was 0.92; the intraobserver ICC was 0.94. A linear correlation was found with the clinical skin score; the Spearman rank correlation test was 0.69.
The correlation with the skin score was reasonable, despite the observation that regional differences in skin elasticity were detected by the cutometer but not by the human observer, who automatically compensates for these factors and integrates them into the skin score. The high interobserver and intraobserver ICC makes the cutometer more suitable for quantifying changes in skin thickness than the subjective skin score.
皮肤评分作为一种对皮肤弹性的主观评估方法，在系统性硬化症患者中广泛应用。尽管这种评分方法被视为一种经过验证且被认可的工具，但其观察者间和观察者内的可重复性相对较差。
我们的目的是研究最近开发的SEM 474皮肤弹性测定仪，该仪器可对皮肤施加可控的真空吸力，是否能比皮肤评分更客观地测量皮肤弹性。
对系统性硬化症患者74个不同身体部位的皮肤弹性进行测量，并与从相同部位获得的皮肤评分进行比较。
皮肤弹性测定仪产生了定量且可重复的数据。大直径（8毫米）测量探头优于小探头。观察者间组内相关系数（ICC）为0.92；观察者内ICC为0.94。发现与临床皮肤评分存在线性相关性；Spearman等级相关检验为0.69。
尽管观察到皮肤弹性测定仪检测到了皮肤弹性的区域差异，而人工观察者却未检测到，且人工观察者会自动补偿这些因素并将其纳入皮肤评分，但与皮肤评分的相关性是合理的。观察者间和观察者内的高ICC值使得皮肤弹性测定仪比主观的皮肤评分更适合量化皮肤厚度的变化。
