Doppler ultrasound, a noninvasive tool for the study of mesenteric arterial flow in systemic sclerosis: a cross-sectional study of a patient cohort with review and meta-analysis of the literature

被引：2

作者：

Giulia Bandini ^{[1
]}

Matteo Monami ^{[2
]}

Gabriele Ciuti ^{[1
]}

Paolo Mercatelli ^{[1
]}

Anna Lo Cricchio ^{[1
]}

Maria Cristina De Santis ^{[1
]}

Francesco Bonomi ^{[3
]}

Silvia Bellando Randone ^{[3
]}

Corrado Campochiaro ^{[4
]}

Khadija El Aoufy ^{[5
]}

Barbara Ruaro ^{[6
]}

Dilia Giuggioli ^{[7
]}

Michael Hughes ^{[8
]}

Zsuzsanna H. McMahan ^{[9
]}

Devis Benfaremo ^{[10
]}

Gianluca Moroncini ^{[11
]}

Giovanni Maconi ^{[12
]}

Esterita Accogli ^{[11
]}

Lorenzo Dagna ^{[12
]}

Marco Matucci Cerinic ^{[13
]}

Alberto Moggi Pignone ^{[14
]}

机构：

[1] University of Florence,Department of Experimental and Clinical Medicine, Division of Internal Medicine

[2] Careggi Hospital,Department of Experimental and Clinical Medicine, Division of Rheumatology

[3] Azienda Ospedaliero Universitaria Careggi and University of Florence,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR)

[4] University of Florence,Department of Experimental and Clinical Medicine

[5] Careggi Hospital,Department of Medical Surgical and Health Sciences

[6] IRCCS San Raffaele Hospital,Rheumatology Unit

[7] University of Florence,Division of Musculoskeletal and Dermatological Sciences

[8] Pulmonology Unit,Division of Rheumatology, Department of Medicine

[9] University Hospital of Cattinara,Department of Clinical and Molecular Sciences

[10] University of Trieste,Department of Internal Medicine

[11] University Hospital of Modena and Reggio Emilia School of Medicine Department of Medical and Surgical Sciences for Children and Adults,Gastroenterology Unit, Department of Biomedical and Clinical Sciences

[12] Northern Care Alliance NHS Foundation Trust,Department of Internal Medicine

[13] Salford Care Organisation,undefined

[14] The University of Manchester,undefined

[15] Manchester Academic Health Science Centre,undefined

[16] UTHealth Houston,undefined

[17] Marche Polytechnic University,undefined

[18] Marche University Hospital,undefined

[19] ASST Fatebenefratelli-Sacco,undefined

[20] University of Milan,undefined

[21] Centre of Research and Learning in Ultrasound,undefined

[22] Maggiore Hospital,undefined

来源：

Internal and Emergency Medicine | 2025年 / 20卷 / 2期

关键词：

Systemic sclerosis; Scleroderma; Bowel vasculopathy; Superior mesenteric artery; Inferior mesenteric artery; Pathogenesis; Outcome measures;

D O I：

10.1007/s11739-024-03783-5

中图分类号：

学科分类号：

摘要：

Gastrointestinal involvement (GI) is a frequent and troublesome complication of systemic sclerosis (SSc), whose etiology is poorly understood, though it is hypothesized that autoimmunity and progressive vasculopathy may play a role. Vasculopathy is considered one of the main pathogenetic pathways responsible for many of the clinical manifestations of SSc, and, therefore, studying the principal splanchnic vessels (i.e., superior mesenteric artery—SMA and inferior mesenteric artery—IMA) with Doppler Ultrasound (DUS) may provide further insights into measuring the progression of vasculopathy, evaluating its possible association with SSc GI symptoms, and determining whether it plays a role in the development or severity of SSc GI disease. A cohort of SSc patients consecutively recruited underwent DUS examination, and associations with GI (UCLA-GIT 2.0 questionnaire) and extraintestinal SSc characteristics were evaluated. Semiquantitative DUS parameters (resistive index—RI and pulsatility index—PI), were applied for splanchnic vessel assessment in SSc patients and healthy subjects (HS). Moreover, a review and meta-analysis of the literature to understand which the values of the main semiquantitative DUS parameters (RI and PI) are both in SSc patients and HS has been conducted. Seventy-eight patients completed DUS examinations and clinical assessments. 30 (39%) were classified as diffuse cutaneous SSc (dcSSC), 35 (45%) as limited cutaneous SSc (lcSSc) and 13 (17%) as sine scleroderma. A significant difference was found both for SMA RI (p for trend = 0.032) and SMA PI (p for trend = 0.004) between patients with sine scleroderma, lcSSc and dcSSc, with lower values observed in the sine scleroderma and lcSSc groups. IMA RI and PI were significantly correlated with GI symptoms such as fecal incontinence (ῥ − 0.33, p = 0.008 and ῥ − 0.30, p = 0.021, respectively). By multivariate analysis, significant associations were confirmed between SMA RI and SMA PI and mRSS (β 0.248, p = 0.030 and β 2.995, p = 0.004, respectively) and with bosentan (β 0.400, p = 0.003 and β 3.508, p = 0.001, respectively), but not with anticentromere antibody (ACA). No significant differences were found between the weighted median values of SMA RI and SMA PI of SSc patients compared to those of HS that were derived from the meta-analysis of the literature (p = 0.72 and p = 0.64, respectively). This cross-sectional study confirms that the splanchnic vasculature of SSc patients can noninvasively been studied with DUS. Vascular splanchnic involvement correlates with the presence and/or severity of specific clinical features in SSc, including GI. Larger and prospective studies are needed to confirm these preliminary observations and to examine the role of DUS in SSc-risk stratification and GI progression and to obtain definitive data regarding both HS and SSc patients splanchnic DUS parameters.

引用

页码：381 / 394

页数：13