目的 本研究通过应用高分辨超声评估SSc患者皮肤增厚程度,探讨其与不同临床指标的相关性,评估其在临床应用方面的优势及不足.方法 选取31例SSc患者和健康对照31名,比较分析组间皮肤厚度、改良Rodnan皮肤评分(mRss)、疾病活动度等不同临床指标,组间比较采用t检验或非参数秩和检验,变量间相关性采用Pearson或Spearman分析,通过受试者工作特征(ROC)曲线评估高频超声皮肤厚度的诊断效率.结果 SSc患者TST与总mRss(r=0.416,P=0.020)、疾病活动度(r=0.436,P=0.014)呈正相关.mRss分别为0、1、2分的患者皮肤厚度均高于健康对照组[1.45(0.60)、1.70(0.30)、1.60(0.30) mm与1.30(0.35) mm,Z=-3.242,-6.577,-5.090,P均<0.01].ROC曲线分析以7.4 mm为阳性标准时,TST诊断皮肤增厚的敏感性77.4%,特异性87.1%.TST升高组患者更易出现肺间质病变(16例与1例,x2=6.004,P=0.014),mRss[10(6)与4(5),Z=-2.499,P=0.031]、疾病活动度[5.2±2.4与2.3±1.7,t=-3.104,P<0.01]、血清CRP [8.6(10.5) mg/L与3.5(4.9) mg/L,Z=-2.276,P=0.038]水平更高.结论 高分辨超声联合mRss技术有助于评估SSc患者的皮肤改变和疾病活动,并且高分辨超声有助于发现SSc早期及亚临床期皮肤受累,为诊断、观察治疗反应、预测脏器损害提供了更客观、有效的手段.
Objective The purpose of this study was to evaluate the degree of skin thickening of patients with systemic sclerosis (SSc) by high-frequecy ultrasound,as well as the value of ultrasound.Methods Thirty-one patients with SSc and 31 age-matched and sex-matched healthy control subjects were enrolled.Skin thickness,modified Rodnan skin score (mRss),disease activity index (DA1) and other clinical parameters within and between groups were compared using SPSS 21 software.Student's t test,x2 test or nonparametric testing was performed to compare between groups.The Pearson or Spearman methods were used to test correlation.Sensitivity and specificity of skin thickness detection by high-frequecy ultrasound were evaluated by using receiver operating characteristic (ROC) curve analysis.Results Total thickness of skin (TST) of patientswith SSc were positively correlated to the total mRss (r=0.416,P=0.020) and DAI (r=0.436,P=0.014).The skin thickness of patients with mRss 0,1,2 was higher than CNT [1.45(0.60),1.70(0.30) mm,1.60 (0.30) mm vs 1.30 (0.35) mm,Z=-3.242,-6.577,-5.090,P<0.01].The cut-off value of TST used as the evaluation of skin change was 7.4 mm by ROC curve analysis,and the sensitivity and specificity of them was 77.40% and 87.10% respectively,and patients with thickened skin were more likely to suffer interstitial lung disease (ILD) (16 vs 1,x2=26.004,P=0.014),higher mRss [10(6) vs 4(5),Z=-2.499,P=0.031],DAI [(5.2±2.4) vs (2.3±1.7),t=-3.104,P<0.01)] and CRP [(8.60 (10.48) mg/L vs 3.52 (4.93) mg/L,Z=-2.276,P=0.038].Conclusion US combined with mRss are helpful to evaluate the changes of skin and disease activity of patients in SSc.US can identify the early and subclinical skin involvement that may precede mRss,providing a more reliable tool for diagnosis,treat efficacy and prediction of organ damage.