目的:评估是否在青少年局限性硬皮病(JLS)中,非侵入性成像可以区分受影响的皮肤与非受影响的皮肤,以及成像是否与经过验证的皮肤评分相关(局部硬皮病皮肤评估工具,LoSCAT)。
方法:将25名JLS患儿纳入一项前瞻性研究,并选择一个“目标”病变。高频超声(HFUS,测量皮肤厚度),红外热成像(IRT,皮肤温度),激光多普勒成像(LDI,皮肤血流量)和多光谱成像(MSI,氧合),在四个部位进行:两个受影响的皮肤(病变的中心和内边缘)和两个未受影响的皮肤(距离病变的“外”和对侧未受影响的一侧边缘1厘米),在4次访问中,间隔3个月。
结果:使用所有4种技术检测到受影响和未受影响的皮肤之间的差异。与未受影响的皮肤相比,受影响的皮肤较薄(p<0.001),温度较高(p<0.001-0.006),灌注(p<0.001-0.039)和氧合(p<0.001-0.028)。皮损活性(LoSCAT)与中心HFUS呈正相关(r=0.32;95%CI[0.02,0.61];p=0.036),与中心LDI呈负相关(r=-0.26;95%CI[-0.49,-0.04];p=0.022)。皮损与中央和内部IRT呈正相关(r=0.43;95%CI[0.19,0.67];p<0.001,r=0.36,95%CI[0.12,0.59];p=0.003),与中央和内部LDI呈正相关(r=0.37;95%CI[0.05,0.69];p=0.024,r=0.41;95%CI[0.08,p=0.74];
结论:非侵入性成像可以检测JLS中受影响和未受影响的皮肤之间的差异,并且可能有助于区分活动(较厚,灌注不好的皮肤)和损伤(更薄,高度灌注的皮肤)。
OBJECTIVE: To evaluate whether in juvenile localized scleroderma (JLS), non-invasive imaging can differentiate affected from non-affected skin and whether imaging correlates with a validated skin score [Localised Scleroderma Cutaneous Assessment Tool (LoSCAT)].
METHODS: A total of 25 children with JLS were recruited into a prospective study and a single \'target\' lesion was selected. High-frequency ultrasound (HFUS, measuring skin thickness), infrared thermography (IRT, skin temperature), laser Doppler imaging (LDI, skin blood flow) and multispectral imaging (MSI, oxygenation) were performed at four sites: two of affected skin (centre and inner edge of lesion) and two of non-affected skin (1 cm from the edge of the lesion \'outer\' and contralateral non-affected side) at four visits at 3 month intervals.
RESULTS: Differences between affected and non-affected skin were detected with all four techniques. Compared with non-affected skin, affected skin was thinner (P < 0.001), with higher temperature (P < 0.001-0.006), perfusion (P < 0.001-0.039) and oxygenation (P < 0.001-0.028). Lesion skin activity (LoSCAT) was positively correlated with centre HFUS [r = 0.32 (95% CI 0.02, 0.61), P = 0.036] and negatively correlated with centre LDI [r = -0.26 (95% CI -0.49, -0.04), P = 0.022]. Lesion skin damage was positively correlated with centre and inner IRT [r = 0.43 (95% CI 0.19, 0.67), P < 0.001 and r = 0.36 (95% CI 0.12, 0.59), P = 0.003, respectively] and with centre and inner LDI [r = 0.37 (95% CI 0.05, 0.69), P = 0.024 and r = 0.41 (95% CI 0.08, 0.74), P = 0.015, respectively].
CONCLUSIONS: Non-invasive imaging can detect differences between affected and non-affected skin in JLS and may help to differentiate between activity (thicker, less well-perfused skin) and damage (thinner, highly perfused skin).