高频超声测量皮肤厚度在弥漫性系统性硬化症中的应用价值

摘要

目的：探讨高频超声测量皮肤厚度在弥漫性系统性硬化症中的应用价值。方法应用高频超声对12例弥漫性系统性硬化症患者和12例年龄、性别匹配的正常对照者分别测量全身17个部位的表皮、真皮及皮肤（包括表皮和真皮）厚度，比较两组间各部位表皮、真皮及皮肤厚度有无差异。17个部位包括双侧指背、手背、前臂、上臂、大腿、小腿、足背及前额、胸壁、腹壁。并分别比较正常对照、临床 Rodnan 皮肤评分0、1、2、3各组间表皮、真皮及皮肤厚度有无差异。结果弥漫性系统性硬化症患者双侧指背[右：0．600（0．200）mm 比0．500（0．200）mm；左：0．550（0．250）mm 比0．500（0．100）mm]、手背[右：1．200（0．700）mm 比0．500（0．200）mm；左：0．750（0．625）mm 比0．500（0．175）mm]、前臂[右：0．800（1．225）mm 比0．500（0．175）mm；左：0．650（0．575）mm 比0．500（0．200）mm]、足背[右：0．750（0．65）mm比0．800（0．525）mm；左：0．550（0．625）mm 比0．400（0．100）mm]及左上臂[0．650（0．300）mm 比0．500（0．100）mm]的真皮厚度高于正常对照组；双侧指背[右：1．000（0．250）mm 比0．800（0．275）mm；左：1．000（0．400）mm 比0．800（0．275）mm]、手背[右：1．550（0．925）mm 比0．800（0．275）mm；左：1．200（0．700）mm 比0．800（0．300）mm]、前臂[右：1．150（1．200）mm 比0．800（0．275）mm；左：1．250（0．850）mm 比0．800（0．300）mm]及足背[右：1．200（0．925）mm比1．150（0．450）mm；左：0．800（0．900）mm 比0．700（0．200）mm]的皮肤厚度高于正常对照组，差异有统计学意义（P ＜0．05）。Rodnan 皮肤评分1、2、3的表皮、真皮及皮肤厚度均高于正常对照组。Rodnan 皮肤评分1、2的真皮及皮肤厚度和Rodnan 评分2的表皮厚度均高于评分0组。结论高频超声测量皮肤厚度有助于评估弥漫性系统性硬化症患者的皮肤改变。%Objective To investigate the utility of high frequency ultrasound measurement of skin thickness in diffuse cutaneous systemic sclerosis(dcSSc).Methods Twelve patients with dcSSc and 12 age and sex matched controls were recruited.The thickness of epidermis, dermis, and full skin (including both epidermis and dermis)were measured by high frequency ultrasound and the skin thickness was compared between dcSSc patients and healthy controls at 17 sites.The 17 sites were bilateral middle fingers,hand dorsum,forearms,upper arms,thigh,lower legs,foot dorsum,forehead,anterior chest,and anterior abdomen.The thickness of epidermis,dermis and full skin were compared between controls,clinical Rodnan skin score 0,1,2 and 3.Results The dermis of bilateral finger [right:0.600 (0.200)mm vs.0.500(0.200)mm;left:0.550(0.250)mm vs.0.500(0.100)mm],hand dorsum [right:1.200 (0.700)mm vs.0.500(0.200)mm;left:0.750(0.625)mm vs.0.500(0.175)mm],forearm [right:0.800(1.225 )mm vs.0.500 (0.175 )mm;left:0.650 (0.575 )mm vs.0.500 (0.200)mm],foot dorsum [right:0.750(0.65)mm vs.0.800(0.525)mm;left:0.550(0.625)mm vs.0.400(0.100) mm]and left upper arm [0.650(0.300)mm vs.0.500(0.100)mm]was thicker in dcSSc patients than controls.The full skin of bilateral finger [right:1.000(0.250)mm vs.0.800(0.275)mm;left:1.000 (0.400)mm vs.0.800(0.275)mm],hand dorsum [right:1.550(0.925)mm vs.0.800(0.275)mm;left:1.200(0.700 ) mm vs.0.800 (0.300 ) mm ], forearm [right: 1.150 (1.200 ) mm vs.0.800 (0.275)mm;left:1.250 (0.850 ) mm vs.0.800 (0.300 ) mm],and foot dorsum [right:1.200 (0.925)mm vs.1.150(0.450)mm;left:0.800(0.900)mm vs.0.700(0.200)mm]was thicker in dcSSc patients than controls.The epidermal,dermal,and full skin thickness were higher in clinical Rodnan score 1,2,3 than controls.The dermal and full skin thickness was higher in score 1,2 than 0.The epidermal thickness was higher in score 2 than 0. Conclusion High frequency ultrasound measurement of skin thickness is feasible and reliable for assessing the skin involvement in dcSSc.