系统性硬化病患者发生胃食管反流症状的病例对照研究  

Case control study of gastroesophageal reflux in patients with systemic sclerosis

作　　者：刘心娟[1] 李梦涛[1] 田庄[2] 徐东[1] 侯勇[1] 王迁[1] 孙秋宁[3] 曾小峰[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,100032 [2]中国医学科学院北京协和医学院北京协和医院心内科,100032 [3]中国医学科学院北京协和医学院北京协和医院皮肤科,100032

出　　处：《中华风湿病学杂志》2012年第7期453-457,共5页Chinese Journal of Rheumatology

基　　金：“十一五”国家科技支撑计划项目（2006BA101A07）;国家自然科学基金（81072485、81071300、81102268）;欧洲抗风湿病联盟硬皮病试验研究（EUSTAR）;首都医学发展基金（2009-2013）;北京协和医院青年科研基金（1604900）

摘　　要：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〉1d；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χ^2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（FEVI％）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。Objective To estimate the characieristics 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 consecu- tively 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. χ^2 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.

关 键 词：硬皮病 系统性 胃食管反流 高血压 肺性 

分 类 号：R593[医药卫生—内科学] R571[医药卫生—临床医学]