背景:四肢萎缩性疾病是系统性硬化症(SSc)的常见并发症,主要与微血管损伤有关。然而,SSc似乎是过早动脉粥样硬化-血栓性疾病的危险因素,可以影响外周动脉,参与营养障碍的发生,促进感染性并发症的发生。这项研究的目的是评估SSc患者四肢动脉疾病的患病率。
方法:在以手部残疾为中心的多学科咨询的背景下连续纳入并收集临床数据[心血管危险因素(CVRF),缺血性营养性疾病的病史,周边脉搏触诊,艾伦操纵上肢(UL)和下肢(LL)],和血液动力学数据(多普勒记录的放射状血流,尺骨,胫骨前后动脉,和测量脚踝的收缩压指数)。
结果:包括14例患者(11例右撇子,2个左撇子,1个灵活的)。男女性别比为0.27,平均年龄为58.1±10.4岁。主要CVRF是年龄和吸烟。在UL,42.8%的患者有营养失调史,艾伦动作异常,掌上弓35.7%,没有感觉到42.9%的尺动脉脉搏,并且25%的尺动脉没有可记录的流量。在LL,14.3%的患者已经出现了营养失调的脚趾,胫骨后动脉15.4%的艾伦动作异常,没有感知到25.6%的胫骨后脉搏,而15.4%的胫骨后动脉血流是病理性的。
结论:远端大血管疾病优先影响尺动脉和胫后动脉,UL的频率较高,LL的频率较低。病理生理学尚不清楚,但可能是SSc的适当表现。似乎有必要使SSc患者严格平衡其CVRF并筛查大血管动脉病变。在这些患者中还存在抗动脉粥样硬化疗法的位置的问题。
BACKGROUND: Trophic disorders of the extremities are a common complication of systemic sclerosis (SSc), mainly related to microvascular damage. However, SSc seems to be a risk factor for premature athero-thrombotic disease that can affect the peripheral arteries, participate in the occurrence of trophic disorders and promote the occurrence of infectious complications. The objective of this study was to assess the prevalence of arterial disease of the limbs in SSc patients.
METHODS: Consecutive inclusions in the context of a multidisciplinary consultation centered on disability of the hand with collection of clinical data [cardiovascular risk factors (CVRF), history of trophic disorders of ischemic origin, peripheral pulse palpation, Allen maneuver the upper (UL) and lower limbs (LL)], and hemodynamic data (flow recorded by Doppler in radial, ulnar, anterior and posterior tibial arteries, and measurement of systolic indices ankles).
RESULTS: Fourteen patients were included (11 right-handers, 2 left-handers, 1 ambidextrous). The sex-ratio male/female was 0.27 and the average age of 58.1±10.4 years. The main CVRF were age and smoking. In the UL, 42.8% of patients had a history of trophic disorders, Allen maneuver was abnormal for 35.7% of the superficial palmar arch, 42.9% of ulnar pulse were not perceived and there was no recordable flow in 25% of ulnar artery. In the LL, 14.3% of patients had already presented trophic disorders toes, Allen maneuver was abnormal for 15.4% of the posterior tibial artery, 25.6% of posterior tibial pulse were not perceived and flow of 15.4% of posterior tibial arteries was pathological.
CONCLUSIONS: The distal macrovascular disease preferentially affecting the ulnar and posterior tibial arteries with a high frequency to the UL and two times less at LL. The pathophysiology is unclear but it could be a proper manifestation of SSc. It seems necessary that SSc patients have a strict balance of their CVRF and a screening of macrovascular arterial lesions. There is also the question of the place of an anti-atherosclerotic therapy in these patients.