常规超声联合弹性成像评估儿童局限性硬皮病活动性病变

Conventional ultrasound combined with elastography for evaluating active lesions of juvenile localized scleroderma

目的观察常规超声联合超声弹性成像技术评估儿童局限性硬皮病(JLS)病变活动程度的价值。方法前瞻性纳入27例JLS患儿、共46处活动性病变,以常规超声对比观察病变与对侧相应对照处皮肤及皮下组织厚度、回声及血流信号;采用剪切波弹性成像(SWE)评估病变与对照处皮肤硬度,以应变弹性成像(SE)评估病变与其周围皮肤的弹性应变率比值,分析个体病变皮肤杨氏模量总和与局限性硬皮病皮肤活动指数(LoSAI)及局限性硬皮病皮肤损伤指数(LoSDI)的相关性。结果相比对照处,46处JLS病变皮肤厚度差异无统计学意义(P>0.05),而皮下组织厚度降低、皮肤杨氏模量增大(P均<0.05)。所有病变皮肤与其周围皮肤的弹性应变率比值均大于2。个体活动性病变皮肤杨氏模量总和与LoSAI呈中度相关(r_(s)=0.63~0.69,P<0.05),而与LoSDI无明显秩相关(r_(s)=0.27~0.33,P>0.05)。结论与对照处相比,JLS活动性病变处皮下组织厚度减低、皮肤硬度增高,且后者越高则JLS病变活动程度越高。

Objective To observe the value of conventional ultrasound combined with ultrasonic elastography for evaluating the severity of active lesions of juvenile localized scleroderma(JLS).Methods Totally 27 JLS children with 46 active lesions were prospectively enrolled.The thickness,echo and blood flow of skin and subcutaneous tissue of JLS lesions and the paired sites were evaluated using conventional ultrasound,while the skin stiffness of all lesions and paired sites were assessed using shear wave elastography(SWE),and the strain ratio of lesions and surrounding skin were evaluated using strain elastography(SE).The thickness,echo and blood flow of skin as well as subcutaneous tissue,and the Young's modulus of skin were compared between JLS active lesions and the paired sites.The correlations of the individual sum total of each Young's modulus and the limited scleroderma activity index(LoSAI)or the limited scleroderma injury index(LoSDI)were explored.Results Compared with the paired site,no significant difference of the skin thickness was found among 46 JLS lesions(P>0.05),but JLS lesions had thinner subcutaneous tissue(P<0.05)and greater Young's moduli(all P<0.05).The strain ratio of the lesions and surrounding skin were all larger than 2.For JLS children with active lesions,the individual sum total of Young's moduli had moderate rank correlations with LoSAI(r_(s)=0.63—0.69,all P<0.05),but there was no significant rank correlation with LoSDI(r_(s)=0.27-0.33,P>0.05).Conclusion Compared with the paired site,JLS active lesions had thinner subcutaneous tissue and stiffer skin.The higher the lesion skin stiffness,the more severe the JLS lesion activity.