重新评估甲襞毛细血管镜在鉴别原发性和继发性雷诺现象以及预测系统性硬化症方面的作用:一项随机观察前瞻性队列研究。

IF 3.9 3区 医学 Q2 IMMUNOLOGY
Expert Review of Clinical Immunology Pub Date : 2024-06-01 Epub Date: 2024-03-11 DOI:10.1080/1744666X.2024.2313642
Marta C Amaral, F Seguro Paula, Joana Caetano, Paul Rj Ames, J Delgado Alves
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引用次数: 0

摘要

背景:原发性雷诺现象(primary Raynaud's phenomenon,简称 pRP)与继发性雷诺现象(secondary Raynaud's phenomenon,简称 sRP)很难区分。虽然甲襞毛细血管镜(NFC)可以检测早期改变,但目前还没有通用的标准来区分原发性雷诺现象和继发性雷诺现象:目的:创建并验证两种 NFC 评分,这两种评分可分别区分 pRP 和 sRP,并可预测系统性硬化症(SSc):我们分别对两组孤立性 RP 患者进行了 NFC 分析,并记录了每视野毛细血管数量、扩大/巨大毛细血管、交叉/畸形、微出血、新生血管生成、稀疏、水肿、血流速度、瘀血。通过多变量回归分析,我们评估了这些特征在 656 例衍生队列患者中的调整预后作用。结果被用于构建基于算法的预后评分(A 和 B)。然后在 219 名患者的确认队列中对这些评分进行了测试:结果:评分 A 无法区分 sRP 和 pRP(任何切点的阴性预测值都较低,阳性预测值都较高);评分 B 无法区分 SSc 或 SSc 病程进展(较低切点的阳性预测值都较低,阴性预测值都较高):结论:被认为具有特异性的 NFC 模式显示出较低的鉴别力,其本身无法可靠地区分 sRP 和 pRP 或预测 SSc 的演变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud's phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study.

Background: Primary Raynaud's phenomenon (pRP) is difficult to distinguish from secondary (sRP). Although nailfold capillaroscopy (NFC) may detect early alterations, no universal criteria yet discriminate between pRP from sRP.

Objectives: To create and validate two NFC scores that could distinguish pRP from sRP and that could predict systemic sclerosis (SSc), respectively.

Methods: We performed NFC on two separate cohorts with isolated RP, and recorded number of capillaries per field, enlarged/giant capillaries, crossed/bizarre patterns, microhemorrhages, neoangiogenesis, rarefaction, edema, blood flow velocity, stasis. By multivariate regression analysis, we evaluated the adjusted prognostic role of these features in a derivation cohort of 656 patients. Results were used to construct algorithm-based prognostic scores (A and B). These scores were then tested on a confirmation cohort of 219 patients.

Results: Score A was unable to discriminate sRP from pRP (low negative predictive values with high positive predictive values for any cut-point); score B was unable to discriminate progression to SSc or a SSc-spectrum disorder (low positive predictive values with high negative predictive values for lower cut-points).

Conclusion: NFC patterns, believed as specific, showed low discriminatory power and on their own are unable to reliably discriminate sRP from pRP or predict evolution to SSc.

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来源期刊
CiteScore
7.60
自引率
2.30%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Expert Review of Clinical Immunology (ISSN 1744-666X) provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in clinical immunology. Members of the International Editorial Advisory Panel of Expert Review of Clinical Immunology are the forefront of their area of expertise. This panel works with our dedicated editorial team to identify the most important and topical review themes and the corresponding expert(s) most appropriate to provide commentary and analysis. All articles are subject to rigorous peer-review, and the finished reviews provide an essential contribution to decision-making in clinical immunology. Articles focus on the following key areas: • Therapeutic overviews of specific immunologic disorders highlighting optimal therapy and prospects for new medicines • Performance and benefits of newly approved therapeutic agents • New diagnostic approaches • Screening and patient stratification • Pharmacoeconomic studies • New therapeutic indications for existing therapies • Adverse effects, occurrence and reduction • Prospects for medicines in late-stage trials approaching regulatory approval • Novel treatment strategies • Epidemiological studies • Commentary and comparison of treatment guidelines Topics include infection and immunity, inflammation, host defense mechanisms, congenital and acquired immunodeficiencies, anaphylaxis and allergy, systemic immune diseases, organ-specific inflammatory diseases, transplantation immunology, endocrinology and diabetes, cancer immunology, neuroimmunology and hematological diseases.
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