系统性硬化病皮肤超声弹性成像评估部位优化及其临床价值

Application of ultrasonic shear wave elastography to the assessment of skin lesion in patients with svstemic sclerosis

目的评价剪切波弹性成像(SWE)在SSc皮肤评估的应用价值及部位优化。方法纳入北京大学第三医院2021年5月至2022年10月连续收治的58例SSc患者及41名体检健康志愿者。在改良Rodnan皮肤评分(mRSS)的17个测量部位进行皮肤SWE检测, 记录剪切波速数值, 评估皮肤硬度。应用SPSS 22.0软件进行分析, 比较SSc患者与健康对照皮肤硬度, 并分析SSc患者皮肤硬度与临床资料的相关性。构建单因素Logistic回归模型, 评估不同部位的SWE对SSc患者诊断效能, 进一步选择最合适的测量部位。结果在除双侧小腿以外的测量部位, SSc患者SWE波速显著高于健康对照组(P<0.05)。在双侧手指、双侧手背、双侧前臂、前胸、腹部、双侧大腿、双侧足背测量部位, SWE波速与mRSS呈正相关。SWE测得剪切波速与欧洲硬皮病研究组疾病活动度评分(EScSG-DAI)(r=0.71, P<0.001)、硬皮病临床试验联合损伤评分(SCTC-DI)(r=0.55, P=0.005)、健康评估问卷残疾指数评分(HAQ-DI)(r=0.46, P=0.003)存在显著相关性。与mRSS比较, SWE更敏感, 可检测亚临床受累部位。减少测量部位至12个(双侧手指、双侧手背、双侧前臂、双侧上臂、前额、前胸、双侧足背), 仍可达到与所有17个部位同时测量相同的评估效能。结论 SWE是反映SSc皮肤病变的良好评估工具, 对疾病的诊断、评估具有重要的意义。可通过进一步规范测量部位, 选择最优评估策略, 从而实现更好的临床应用。

Objective To evaluate the value of shear wave elastography(SWE)in skin assessment of Systemic sclerosis(SSc).Methods A total of 58 SSc patients admitted to Peking University Third Hospital from May 2021 to October 2022 and 41 healthy volunteers were included in the study.Skin shear wave elastography(SWE)was performed at 17 sites defined in modified Rodnan skin score(mRSS)measurement,and shear wave velocity values were recorded to evaluate skin hardness.SPSS 22.0 software was used to analyze the skin hardness of SSc patients and healthy controls,and the correlation between skin hardness of SSc patients and clinical data was analyzed.A logistic regression model was constructed to evaluate the diagnostic efficacy of skin hardness at different sites of SSc patients,and to further select the most practical measurement site.Results The SWE value of SSc patients was significantly higher than that of healthy control group(P<0.05).There was a positive correlation between SWE and mRSS in the measurement of bilateral fingers,bilateral dorsal hands,bilateral forearms,fore-chest,abdomen,bilateral thighs,and bilateral dorsal feet.Skin stiffness measured by SWE was significantly correlated with SSc disease activity score(EScSG-DAI),(r=0.71,P<0.001),disease injury score(SCTC-DI),(P=0.55,P=0.005)and functional score(HAQ-DI),(r=0.46,P=0.003).Reducing the number of measurement sites to 12(bilateral fingers,bilateral hands,bilateral forearms,bilateral upper arms,forehead,fore-chest,bilateral dorsum of feet)performs as well as all 17 measurement sites simultaneously in assessing disease activity.Conclusion SWE is a good evaluation tool to reflect the skin lesions of SSc,which is of great value for the diagnosis and evaluation of the disease.We can further standardize the measurement sites and select the most appropriate evaluation strategy,so as to achieve better clinical application.