CAJ | 학술논문

目的探讨中国人群系统性硬化病(SSc)患者胃食管反流症状(GER)的发生率及其与肺动脉高压(PAH)的相关性.方法对北京协和医院风湿免疫科205例SSc患者进行研究；GER定义为轻中度烧心和(或)反酸每周大于2d,重度烧心和(或)反酸每周＞1 d;评价患者的临床表现、实验室检查及6min步行距离(6MWD)、心脏超声、肺功能和改良Rodnan皮肤评分(mRSS).应用x2检验和Fisher确切概率法、t检验对资料进行分析;用Logistic回归模型进行危险因素的分析.结果在205例SSc患者中43.9％(90/115)合并有GER;合并GER的患者雷诺现象(98.9％与92.2％)、指端溃疡(56.7％与51.3％)、PAH(23.3％与9.6％)和其他消化系统表现的发生率明显高于不合并GER者(non-GER,P＜0.05);在GER组和non-GER组之间各种自身抗体的阳性率差异都无统计学意义;心脏超声显示GER组的左心室射血分数(LVEF)下降[(67±10)％与(70±5)％];纽约心脏病学会(NYHA)分级显示GER组心功能下降(P=0.015);肺功能检查显示GER组用力肺活量占预计值百分比(FVC％),第1秒用力呼气量占预计值百分比(FEV1％)和肺CO弥散量占预计值百分比(DLCO％)较non-GER组下降,FVC％/DLCO％较non-GER组升高(P＜0.05);GER是SSc患者PAH发生的独立危险因素(P=0.047,OR=3.41).结论 GER是SSc患者常见的并发症,其发病与血管病变有关,合并GER的SSc患者应接受PAH的筛查.
목적 탐토중국인군계통성경화병(SSc)환자위식관반류증상(GER)적발생솔급기여폐동맥고압(PAH)적상관성.방법 대북경협화의원풍습면역과205례SSc환자진행연구；GER정의위경중도소심화(혹)반산매주대우2d,중도소심화(혹)반산매주＞1 d;평개환자적림상표현、실험실검사급6min보행거리(6MWD)、심장초성、폐공능화개량Rodnan피부평분(mRSS).응용x2검험화Fisher학절개솔법、t검험대자료진행분석;용Logistic회귀모형진행위험인소적분석.결과 재205례SSc환자중43.9％(90/115)합병유GER;합병GER적환자뢰낙현상(98.9％여92.2％)、지단궤양(56.7％여51.3％)、PAH(23.3％여9.6％)화기타소화계통표현적발생솔명현고우불합병GER자(non-GER,P＜0.05);재GER조화non-GER조지간각충자신항체적양성솔차이도무통계학의의;심장초성현시GER조적좌심실사혈분수(LVEF)하강[(67±10)％여(70±5)％];뉴약심장병학회(NYHA)분급현시GER조심공능하강(P=0.015);폐공능검사현시GER조용력폐활량점예계치백분비(FVC％),제1초용력호기량점예계치백분비(FEV1％)화폐CO미산량점예계치백분비(DLCO％)교non-GER조하강,FVC％/DLCO％교non-GER조승고(P＜0.05);GER시SSc환자PAH발생적독립위험인소(P=0.047,OR=3.41).결론 GER시SSc환자상견적병발증,기발병여혈관병변유관,합병GER적SSc환자응접수PAH적사사.
Objective To estimate the characteristics of gastroesophageal reflux (GER) and its clinical association with pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) patients.Methods Two hundred and five patients with SSc,who fulfilled the American College of Rheumatology criteria were consecutively recruited.GER was recognized in patients with symptom of heartburn or regurgitation.Demographic,clinical,and laboratory data were analyzed.A six minute walk test,pulmonary function test and modified Rodnan's skin score (mRSS) were also calculated for GER and non-GER groups.x2 test,Fisher's exact test and t-test were used for statistical analysis.Logistic regression test was used for the analysis of risk factors.Results There were 90 patients with GER among 205 patients,the prevalence of GER was 43.9％.The presence of PAH (23.3％ vs 9.6％),Raynaud's phenomenon (98.9％ vs 92.2％ ) and fingertip ulcers (56.7％vs 51.3％) were significantly higher in patients with GER than those without GER.There was no difference in autoantibody profile between GER patients and non-GER patients (P＞0.05).The New York Heart Association (NYHA) functional class of SSc-related GER was worse than patients without GER (P=0.015).Pulmonary function test showed that diffuse capacity (DLCO)％,forced vital capacity (FVC)％,and forced expiratory volume (FEV1)％ were lower and the FVC％/DLCO％ ratio was higher in patients with GER than non-GER (P＜0.05).GER was an independent risk factor of PAH in SSc patients (P=0.047,OR=3.41 ).Conclusion GER frequently occurs in SSc patients,SSc patients presenting with GER should be screened for PAH.Targeting the underlying vascular dysfunction might prevent not only PAH,but also GER in SSc patients.