【摘要】 目的 探讨系统性硬化症合并肢端溃疡(SSc-DUs)的临床特征及其与脏器受累和自身抗体之间的关联，以增加对该病的认识。方法 回顾性分析70例SSc-DUs患者的临床资料，对溃疡发生部位及脏器受累情况等进行分析；与155例系统性硬化症无合并肢端溃疡(SSc-No-DUs)患者的临床资料进行对比，分析SSc-DUs与脏器受累、自身抗体等之间的关联。结果 SSc-DUs患者的溃疡好发部位依次是指尖(51.43%)、指间关节(22.86%)和足趾(15.71%),足跟、肘关节和踝关节相对较少。SSc-DUs患者中的心力衰竭(31.42%)、食管受累(65.71%)的发生比例均高于SSc-No-DUs组(19.35%,40.65%,χ~2值分别为0.01、12.13,均P<0.05),而两组之间肺、肾、甲状腺疾病的发生率差异无统计学意义(均P>0.05)。SSc-DUs组中的抗Scl-70抗体阳性率(80.00%)、抗SSA抗体阳性率(38.57%)、抗Ro-52抗体阳性率(22.86%)均高于SSc-No-DUs组(均P<0.05),而两组间抗核抗体阳性滴度及核型分布、免疫球蛋白及补体C3、C4阳性率差异均无统计学意义(均P>0.05)。结论 SSc-DUs患者的溃疡好发部位多见于指尖和指间关节。SSc-DUs患者更易出现食道累及和心力衰竭。抗Scl-70抗体(+)、抗SSA抗体(+)和抗Ro-52抗体(+)可能是溃疡发生的危险信号。更多还原

【Abstract】 Objective To explore the characteristics of systemic sclerosis with acro-ulceration(SSc-DUs) and its association with organ involvement and autoantibodies in order to improve the understanding of the disease. Methods The clinical data of 70 patients with SSc-DUs were analyzed retrospectively, and the sites of ulcer and organ involvement were also analyzed. The clinical data of 155 patients with systemic sclerosis without acroulcers(SSc-No-DUs) were used as controls to assess the association between SSc-DUs and organ involvement and autoantibodies. Results The most common sites of ulcers were the fingertips(51.43%), interphalangeal joints(22.86%) and toes(15.71%), while the involvements of the heel, elbow and ankle joints were relatively rare. The rates of heart failure(31.42%) and esophageal involvement(65.71%) in SSc-DUs group were higher than those in SSc-No-DUs group(both P<0.05). The positive rates of anti-SCL-70 antibody(80.00%), anti-SSA antibody(38.57%) and anti-Ro-52 antibody(22.86%) in SSc-DUs group were higher than those in SSc-No-DUs group(all P<0.05). There were no significant differences in the incidence of the lung, kidney and thyroid diseases, positive titer of anti-nuclear antibody, typing of anti-nuclear antibody, immunoglobulin and complement levels between the two groups(all P>0.05).Conclusions The ulcers in patients with SSc-DUs are more common in the fingertips and interphalangeal joints. SSc-DUs patients are more likely to have esophageal involvement and a higher incidence of heart failure. Anti-Scl-70 antibody(+), anti-SSA antibody(+), and anti-Ro-52 antibody(+) may be danger signs of the development of ulcers.更多还原