The 'distal-dorsal difference': a thermographic parameter by which to differentiate between primary and secondary Raynaud's phenomenon
The 'distal-dorsal difference': a thermographic parameter by which to differentiate between primary and secondary Raynaud's phenomenon
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DOI：
10.1093/rheumatology/kel330
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发表时间：
2007-03-01
期刊：
影响因子：
5.5
通讯作者：
Herrick, A. L.
中科院分区：
文献类型：
--
作者：
Anderson, M. E.;Moore, T. L.;Herrick, A. L.
客观的。为了检验这样的假设：在患有雷诺现象 (RP) 的患者中，指尖和手背之间 > 1 摄氏度的差异 [“远端-背侧差异” (DDD)，手指温度较低] 对于系统性硬化症 (SSc) 中发生的潜在结构性血管疾病具有特异性，并评估区分继发性和原发性 RP 的其他热成像参数。方法。对参加热成像的患者的病例记录和热成像结果进行回顾性分析，主要是在 2 年期间。多项 Logistic 回归用于确定原发性 RP（56 名患者）、未分化结缔组织病（21 名患者）和 SSc（45 名患者）组之间的热成像变量是否存在差异，并调整了年龄、性别和吸烟情况。结果。在识别继发于 SSc 的 RP 患者时，任何手指在 30°C 下 DDD > 1°C 的阳性预测值为 70%，阴性预测值为 82%。根据多项 Logistic 回归的结果，得出一个分数，其中包含年龄、30 摄氏度时 DDD > 1 摄氏度的手指数量以及最大复温梯度。该评分（具有合适的截止值）在识别继发于 SSc 的 RP 方面的敏感性为 82%，特异性为 82%，阳性预测值为 73%，阴性预测值为 89%。结论。来自热成像的参数（包括热和冷挑战）有助于预测 RP 患者的 SSc。
Objective. To test the hypothesis that in a patient with Raynaud's phenomenon (RP), a difference of > 1 degrees C between the fingertips and the dorsum of the hand ['distal-dorsal difference' (DDD), fingers cooler] is specific for underlying structural vascular disease as occurs in systemic sclerosis (SSc), and to evaluate other thermographic parameters in the separation of secondary from primary RP.Methods. A retrospective analysis of the case notes and thermography results of patients attending thermography, primarily over a 2-yr period. Multinomial logistic regression was used to ascertain whether thermography variables differed between groups with primary RP (56 patients), undifferentiated connective tissue disease (21 patients) and SSc (45 patients), with adjustment for age, sex and smoking.Results. A DDD > 1 degrees C in any finger at 30 degrees C had a positive predictive value of 70%, and a negative predictive value of 82%, in identifying the patient with RP secondary to SSc. From the results of the multinomial logistic regression, a score was derived incorporating age, number of fingers with DDD > 1 degrees C at 30 degrees C and maximum rewarming gradient. This score (with a suitable cut-off) was 82% sensitive and 82% specific in identifying RP secondary to SSc, with a positive predictive value of 73% and a negative predictive value of 89%.Conclusion. Parameters derived from thermography (incorporating both a heat and cold challenge) aid in the prediction of SSc in patients with RP.