Pulmonary involvement in systemic sclerosis: Associations with genetic, serologic, sociodemographic, and behavioral factors
Pulmonary involvement in systemic sclerosis: Associations with genetic, serologic, sociodemographic, and behavioral factors
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DOI：
10.1002/art.22532
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发表时间：
2007-03-15
期刊：
影响因子：
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通讯作者：
Mayes, Maureen D.
中科院分区：
文献类型：
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作者：
McNearney, Terry A.;Reveille, John D.;Mayes, Maureen D.
Objective.在硬皮病的遗传与环境结局研究队列中，确定遗传、临床、血清学、社会人口学和行为/心理学变量对早期肺部受累的相对贡献。在基线访视（V0）时，对203例系统性硬化症（SSc）患者进行了检查（104例白人，39例非洲裔美国人和60例西班牙裔）。我们获得了社会人口统计学、行为/心理（疾病行为、社会支持、习得性无助、吸烟、饮酒）、临床、血清学（自身抗体）和遗传（HLA II类和FBN 1基因型）因素;肺功能测试结果;心电图;胸片。资料分析采用Fisher精确检定、卡方检定、Student t检定、变异数分析、逐步线性回归及逻辑斯谛回归等方法。在SSc诊断的2.8年内，在25%的患者中观察到显著的肺部受累。在V0时，非裔美国人的肺纤维化显著高于白人或西班牙裔。与白人相比，非裔美国人的用力肺活量（FVC）和1秒用力呼气量（FEV 1）预测百分比显著较低，一氧化碳弥散量（DLco）预测百分比显著较低。影响早期肺部受累的显著独立相关因素包括非裔美国人种族、皮肤评分、血清肌酐和肌酸磷酸激酶值、甲状腺功能减退和心脏受累。抗着丝粒抗体血清阳性是限制性肺疾病和FVC或DLco值的重要、独立、保护性因素。与白人相比，非裔美国人的抗拓扑异构酶I，原纤维蛋白和RNP自身抗体的频率显着增加。非裔美国人得分显着较低的人际支持评估列表和显着较高的疾病行为量表。SSc的早期肺部受累似乎受到种族因素的影响，包括种族、社会经济、行为和血清学决定因素。
Objective. To determine the relative contributions of genetic, clinical, serologic, sociodemographic, and behavioral/ psychological variables to early pulmonary involvement in the Genetics versus Environment in Scleroderma Outcome Study cohort.Methods. At the baseline visit (V0), 203 patients with systemic sclerosis (SSc) were examined (104 whites, 39 African Americans, and 60 Hispanics). We obtained sociodemographic, behavioral/psychological (illness behavior, social support, learned helplessness, smoking, drinking), clinical, serologic (autoantibodies), and genetic (HLA class II and FBN1 genotypes) factors; pulmonary function test results; electrocardiograms; and chest radiographs. Data analysis included Fisher's exact test, chi-square test, Student's t-test, analysis of variance, and stepwise linear and logistic regression methods.Results. Significant pulmonary involvement was seen in 25% of patients within 2.8 years of SSc diagnosis. At V0, pulmonary fibrosis was significantly higher in African Americans compared with whites or Hispanics. African Americans had significantly lower percent predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) compared with whites and significantly lower percent predicted diffusing capacity for carbon monoxide (DLco) compared with whites and Hispanics. Significant, independent associations impacting early pulmonary involvement included African American ethnicity, skin score, serum creatinine and creatine phosphokinase values, hypothyroidism, and cardiac involvement. Anticentromere antibody seropositivity was a significant, independent, protective factor for restrictive lung disease and FVC or DLco values. African Americans had significantly increased frequencies of antitopoisomerase I, fibrillarin, and RNP autoantibodies compared with whites. African Americans scored significantly lower on the Interpersonal Support Evaluation List and significantly higher on the Illness Behavior Questionnaire.Conclusion. Early pulmonary involvement in SSc appears to be influenced by several factors delineated by ethnicity, including racial, socioeconomic, behavioral, and serologic determinants.