超微血流显像评价系统性硬化症指端血流的方法学与临床应用

doi:10.19723/j.issn.1671-167X.2023.04.011

摘要/Abstract

摘要：

目的: 探讨超微血流显像(superb microvascular imaging，SMI)评估系统性硬化症(systemic sclerosis, SSc)指端微循环损伤的可行性及其最佳应用条件，并确定检查部位(甲床和指腹)、切面(短轴切面和长轴切面)及增益对检查结果的影响。方法: 收集自2022年2—10月在北京大学第三医院诊治的32例SSc患者及32名非SSc患者。通过SMI对两组患者的指端血流进行评估，在不同切面(双手中指的甲床长轴及短轴、指腹长轴及短轴)和不同增益条件，即高增益(40 dB)及低增益(35 dB)下分别观察血流信号的分布，测量血管指数(vascular index，VI)并进行比较。结果: 对照组中指指端血流分布丰富，SMI模式下可清晰观察到走行于远端指骨背侧的甲床内小动脉，并发出多发垂直分支向甲面走行；指腹切面可观察到与皮肤横向走行的小动脉，发出垂直分支向皮肤走行，在皮下呈类网状分布。SSc组患者甲床及指腹的血流分布减少，动脉显示不连续，只显示零星点状或短棒状血流信号。不同部位、切面及血流增益条件下，SSc组血管指数均显著低于对照组(P＜0.001)。不同部位及切面比较发现，甲床长轴切面的诊断效能最高，受试者工作特性曲线下面积(the area under the receiver operating characteristic curve，AUC)最大。低增益条件下，甲床长轴切面AUC为0.871，截断值为5.4%，敏感性为90.6%，特异性为74.2%；高增益条件下，甲床长轴切面的AUC为0.893，截断值14.0%，敏感性为75.0%，特异性为93.6%。多因素分析结果显示甲床长轴切面对于患病的诊断影响差异均存在统计学意义(高增益条件，P＜0.005；低增益条件，P＜0.05)。结论: SMI可用于评估SSc患者的血管异常改变。高增益下使用甲床长轴切面方便易行，且能够特异地评估SSc患者的微循环变化。

关键词: 系统性硬化症, 超微血流显像, 微循环

Abstract:

Objective: To explore the feasibility of superb microvascular imaging (SMI) in evaluating microcirculation damage of the finger of systemic sclerosis (SSc), and determining the optimal scanning method by assessing the effect of scanning position (finger pulp or nail bed), plane (transverse or sagittal) and Doppler gain on the results. Methods: In the study, 32 SSc patients and 32 non-SSc volunteers admitted to Peking University Third Hospital from February to October 2022 were included. The SMI image under different gain set (40 dB or 35 dB) of the third fingertip (sagittal scans or transverse scan of nail bed or pulp) of both hands were collected while vascular index (VI) was measured. Results: Non-SSc volunteer presented abundant SMI signal distributed in the third fingertip. Arteriole of nail bed was observed on the dorsal side of the distal phalanx under SMI and gave off multiple vertical branches towards the nail. The arteriole of finger pulp ran parallel to the skin and gave off vertical branches towards the skin distributing subcutaneously as a network. In SSc group, the SMI signal in nail bed and finger pulp was reduced. The arteriole of nail bed and finger pulp was discontinuous and presented as sporadic dots and short rod-like color signal under SMI. The vascular index of the SSc patients was significantly lower than that of the non-SSc controls (P < 0.001). Among different positions and sections, the area under the receiver operating characteristic curve (AUC) of the sagittal plane of nail bed was the highest. Under low gain, the AUC of sagittal plane of nail bed was 0.871, the cut-off value was 5.4%, the sensitivity was 90.6%, and the specificity was 74.2%. Under high gain, the AUC was 0.893, the cut-off value was 14.0%, the sensitivity was 75.0%, and the specificity was 93.6%. Multivariate analysis showed that there was statistical significance on the diagnostic impact of the sagittal plane of nail bed (P < 0.005 for high gain condition; P < 0.05 for low gain condition). Conclusion: SMI can be used to evaluate the abnormal changes of vascular in patients with SSc. Using the sagittal scan of nail bed with high gain can evaluate the vascular loss of the fingertip in SSc patient accurately and specifically.

Key words: Systemic sclerosis, Superb microvascular imaging, Microcirculation

中图分类号:

R593.25

林卓华,蔡如意,孙洋,穆荣,崔立刚. 超微血流显像评价系统性硬化症指端血流的方法学与临床应用[J]. 北京大学学报（医学版）, 2023, 55(4): 636-640.

Zhuo-hua LIN,Ru-yi CAI,Yang SUN,Rong MU,Li-gang CUI. Methodology and clinical use of superb microvascular imaging in assessing micro-circulation changes of fingertips in systemic sclerosis[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 636-640.

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参考文献 21

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Scanning method	SSc group	Control group	P
Low gain (35 dB)
Sagittal plane of finger pulp	2.8 (0.6, 6.7)	12.0 (7.1, 14.3)	＜0.001
Transverse plane of finger pulp	4.2 (0.8, 8.6)	10.8 (6.8, 16.9)	＜0.001
Sagittal plane of nail bed	1.0 (0.6, 3.5)	14.2 (4.8, 20.0)	＜0.001
Transverse plane of nail bed	2.4 (0.9, 4.3)	12.8 (7.2, 16.7)	＜0.001
High gain (40 dB)
Sagittal plane of finger pulp	14.1 (5.0, 21.4)	26.0 (17.3, 36.5)	＜0.001
Transverse plane of finger pulp	10.6 (7.5, 20.4)	34.7 (20.4, 50.4)	＜0.001
Sagittal plane of nail bed	10.4 (5.9, 14.5)	38.2 (22.5, 58.0)	＜0.001
Transverse plane of nail bed	18.1 (8.1, 32.9)	41.1 (23.6, 60.2)	＜0.001

Scanning method	Cut-off value/%	AUC (95%CI)	Sensitivity/%	Specificity/%
Low gain (35 dB)
Transverse plane of nail bed	6.6	0.861 (0.751-0.935)	93.8	77.4
Sagittal plane of nail bed	5.4	0.871 (0.763-0.942)	90.6	74.2
Transverse plane of finger pulp	5.1	0.793 (0.673-0.885)	71.9	83.9
Sagittal plane of finger pulp	6.1	0.805 (0.686-0.894)	75.0	80.7
High gain (40 dB)
Transverse plane of nail bed	45.3	0.790 (0.669-0.882)	96.9	48.4
Sagittal plane of nail bed	14.0	0.893 (0.790-0.957)	75.0	93.6
Transverse plane of finger pulp	20.8	0.836 (0.721-0.917)	78.1	74.2
Sagittal plane of finger pulp	23.9	0.765 (0.641-0.863)	90.6	54.8

Scanning method	Exp (B)	P
Low gain (35 dB)
Sagittal plane of finger pulp	0.940	0.529
Transverse plane of finger pulp	1.048	0.645
Sagittal plane of nail bed	0.779	0.017
Transverse plane of nail bed	0.928	0.334
High gain (40 dB)
Sagittal plane of finger pulp	0.930	0.467
Transverse plane of finger pulp	0.984	0.709
Sagittal plane of nail bed	0.884	0.004
Transverse plane of nail bed	1.048	0.492

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