PDF(Pubmed)
Abstract：
UNASSIGNED: Ischemic digital ulcers (DUs) are frequent and severe complications of systemic sclerosis (SSc). Treatment options for SSc-related digital vasculopathy are based on aggressive vasodilation, with the objective to improve blood flow in ischemic areas. Intravenous prostanoids are recommended to treat active DUs. However, the level of evidence for the duration of 5 days is low. Therefore, the aim of this study was to determine whether prolonging the infusion beyond 5 days increases the rate of healing of active DUs in SSc.
UNASSIGNED: This is an observational longitudinal retrospective bicenter study from 2000 to 2017. The objective was to compare the healing rate and time (defined by a healing of at least 50% of DUs) between two durations of iloprost administration: 5 days or less, or more than 5 days.
UNASSIGNED: Forty-one patients, with a mean age of 47 ± 15 years at diagnosis and 32 (78%) females have been included. Systemic sclerosis was diffuse in 10 (24%) cases and 13 (32%) had an interstitial lung disease. A total of 243 iloprost infusions for DUs were performed: 140 infusions for 5 days or less, and 103 infusions for more than 5 days (prolonged duration). Patients with active DUs which received >5 days of iloprost had higher modified Rodnan skin scale at the time of iloprost infusion (median 33 vs. 15; p < 0.05), more interstitial lung disease (44 vs. 27%; p < 0.05), more anti-topoisomerase I antibody positivity (59 vs. 44%; p < 0.05), and received more previous cyclophosphamide therapy (48 vs. 19%; p < 0.05). While the number of active DUs before iloprost infusion was not significantly different among those who received ≤5 days and >5 days of iloprost, the time to healing after iloprost infusion significantly decreased in SSc patients who received >5 days iloprost infusion: 48 [7-392] vs. 91 [9-365] days (p < 0.05). The proportion of SSc patients with healed DUs tended to increase in patients with >5 days iloprost infusion (log rank = 0.06). The number of patients with complete DU healing at day 90 was significantly increased in SSc who received >5 days of iloprost: 53 (51%) vs. 52 (37%) (p < 0.05). In addition, the time to healing was not significantly associated with the use of calcium channel blockers, endothelin receptor antagonists or a combination of PDE-5 inhibitors.
UNASSIGNED: Prolonging duration of iloprost >5 days could improve the healing rate and the time to healing of SSc-related DUs. Prospective randomized studies are needed to confirm these data and define the optimal duration of iloprost therapy.
UNASSIGNED: This is an observational longitudinal retrospective bicenter study from 2000 to 2017. The objective was to compare the healing rate and time (defined by a healing of at least 50% of DUs) between two durations of iloprost administration: 5 days or less, or more than 5 days.
UNASSIGNED: Forty-one patients, with a mean age of 47 ± 15 years at diagnosis and 32 (78%) females have been included. Systemic sclerosis was diffuse in 10 (24%) cases and 13 (32%) had an interstitial lung disease. A total of 243 iloprost infusions for DUs were performed: 140 infusions for 5 days or less, and 103 infusions for more than 5 days (prolonged duration). Patients with active DUs which received >5 days of iloprost had higher modified Rodnan skin scale at the time of iloprost infusion (median 33 vs. 15; p < 0.05), more interstitial lung disease (44 vs. 27%; p < 0.05), more anti-topoisomerase I antibody positivity (59 vs. 44%; p < 0.05), and received more previous cyclophosphamide therapy (48 vs. 19%; p < 0.05). While the number of active DUs before iloprost infusion was not significantly different among those who received ≤5 days and >5 days of iloprost, the time to healing after iloprost infusion significantly decreased in SSc patients who received >5 days iloprost infusion: 48 [7-392] vs. 91 [9-365] days (p < 0.05). The proportion of SSc patients with healed DUs tended to increase in patients with >5 days iloprost infusion (log rank = 0.06). The number of patients with complete DU healing at day 90 was significantly increased in SSc who received >5 days of iloprost: 53 (51%) vs. 52 (37%) (p < 0.05). In addition, the time to healing was not significantly associated with the use of calcium channel blockers, endothelin receptor antagonists or a combination of PDE-5 inhibitors.
UNASSIGNED: Prolonging duration of iloprost >5 days could improve the healing rate and the time to healing of SSc-related DUs. Prospective randomized studies are needed to confirm these data and define the optimal duration of iloprost therapy.
摘要：
■缺血性数字溃疡（DU）是系统性硬化症（SSc）的常见和严重并发症。SSc相关数字血管病变的治疗选择基于积极的血管舒张，目的是改善缺血区的血流。建议静脉使用前列腺素类药物治疗活跃的DU。然而,持续5天的证据水平较低。因此,这项研究的目的是确定延长输注时间超过5天是否会增加SSc中活跃DU的治愈率。
■这是一项2000年至2017年的观察性纵向回顾性双中心研究。目的是比较两个伊洛前列素给药持续时间之间的治愈率和时间（由至少50％的DU愈合定义）：5天或更短，或超过5天。
■41名患者，诊断时平均年龄为47±15岁，包括32名（78％）女性。系统性硬化症在10例（24％）中弥漫性，而13例（32％）患有间质性肺病。总共进行了243次伊洛前列素输注治疗：140次输注治疗5天或更少，和103次输注超过5天（持续时间延长）。接受伊洛前列素治疗>5天的活跃DU患者在输注伊洛前列素时的改良Rodnan皮肤量表较高（中位数33vs.15；p<0.05)，更多间质性肺病(44vs.27%；p<0.05)，更多的抗拓扑异构酶I抗体阳性(59vs.44%；p<0.05)，并接受了更多以前的环磷酰胺治疗(48vs.19%；p<0.05)。虽然在接受≤5天和>5天伊洛前列素治疗的患者中，伊洛前列素输注前的活跃DU数量没有显着差异，在接受伊洛前列素输注>5天的SSc患者中，伊洛前列素输注后的愈合时间显着减少：48[7-392]vs.91[9-365]天（p<0.05）。在输注伊洛前列素>5天的患者中，具有治愈的DU的SSc患者的比例趋于增加（logrank=0.06）。在接受伊洛前列素>5天的SSc中，在第90天完成DU愈合的患者数量显着增加：53（51％）与52(37%)(p<0.05)。此外,愈合时间与钙通道阻滞剂的使用没有显着相关，内皮素受体拮抗剂或PDE-5抑制剂的组合。
■延长伊洛前列素的持续时间>5天可以提高SSc相关DU的治愈率和愈合时间。需要前瞻性随机研究来确认这些数据并确定伊洛前列素治疗的最佳持续时间。
■这是一项2000年至2017年的观察性纵向回顾性双中心研究。目的是比较两个伊洛前列素给药持续时间之间的治愈率和时间（由至少50％的DU愈合定义）：5天或更短，或超过5天。
■41名患者，诊断时平均年龄为47±15岁，包括32名（78％）女性。系统性硬化症在10例（24％）中弥漫性，而13例（32％）患有间质性肺病。总共进行了243次伊洛前列素输注治疗：140次输注治疗5天或更少，和103次输注超过5天（持续时间延长）。接受伊洛前列素治疗>5天的活跃DU患者在输注伊洛前列素时的改良Rodnan皮肤量表较高（中位数33vs.15；p<0.05)，更多间质性肺病(44vs.27%；p<0.05)，更多的抗拓扑异构酶I抗体阳性(59vs.44%；p<0.05)，并接受了更多以前的环磷酰胺治疗(48vs.19%；p<0.05)。虽然在接受≤5天和>5天伊洛前列素治疗的患者中，伊洛前列素输注前的活跃DU数量没有显着差异，在接受伊洛前列素输注>5天的SSc患者中，伊洛前列素输注后的愈合时间显着减少：48[7-392]vs.91[9-365]天（p<0.05）。在输注伊洛前列素>5天的患者中，具有治愈的DU的SSc患者的比例趋于增加（logrank=0.06）。在接受伊洛前列素>5天的SSc中，在第90天完成DU愈合的患者数量显着增加：53（51％）与52(37%)(p<0.05)。此外,愈合时间与钙通道阻滞剂的使用没有显着相关，内皮素受体拮抗剂或PDE-5抑制剂的组合。
■延长伊洛前列素的持续时间>5天可以提高SSc相关DU的治愈率和愈合时间。需要前瞻性随机研究来确认这些数据并确定伊洛前列素治疗的最佳持续时间。
