Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis
Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis
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DOI：
10.1002/acr.23479
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发表时间：
2018-09-01
影响因子：
4.7
通讯作者：
Hummers, Laura K.
中科院分区：
文献类型：
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作者：
McMahan, Zsuzsanna H.;Paik, Julie J.;Hummers, Laura K.
目标。一部分系统性硬化症（SSc）患者出现严重的胃肠（GI）运动障碍。我们试图确定严重SSc胃肠道运动障碍的预测因素，并确定与该表型相关的独特特征。在横断面分析中，将需要补充营养（肠内或肠外管喂养）的SSc患者与轻度胃肠道症状的SSc患者进行比较。使用逻辑回归检查了严重的胃肠道运动障碍与临床和血清学特征之间的关系。使用Cox回归检查基线数据以确定发生严重胃肠道功能障碍的预测因素。伴有严重胃肠道运动障碍的SSc患者（n = 66）比伴有轻度胃肠道症状的患者（n = 1736）更有可能是男性(优势比[OR] 2.47[95%可信区间（95% CI） 1.34-4.56]；P = 0.004)，有肌病（OR 5.53 [95% CI 2.82-10.82]; P < 0.001）和镰状病症状（OR 2.40 [95% CI 1.30-4.42]; P = 0.005），甚至在校正潜在混杂因素后也是如此。与未来严重胃肠道功能障碍发展相关的基线特征包括男性（风险比[HR] 2.99 [95% CI 1.53-5.84]; P = 0.001）和肌病（风险比[HR] 5.08 [95% CI 2.21-11.67]; P < 0.001）。SSc患者有发展为严重胃肠道运动障碍的危险，其临床特征明显。这一发现不仅具有重要的临床意义，而且表明在这些患者中有一种独特的病理过程在起作用。
Objective. A subset of patients with systemic sclerosis (SSc) develop severe gastrointestinal (GI) dysmotility. We sought to determine predictors of severe SSc GI dysmotility and to identify distinct features associated with this phenotype.Methods. Patients with SSc, who required supplemental nutrition (enteral or parenteral tube feeding) were compared to SSc, patients with mild GI symptoms in a cross-sectional analysis. The association between severe GI dysmotility and clinical and serologic features was examined using logistic regression. Baseline data were examined to determine predictors of developing severe GI dysfunction using Cox regression.Results. SSc patients with severe GI dysmotility (n = 66) were more likely than those patients with mild GI symptoms (n = 1,736) to be male (odds ratio [OR] 2.47 [95% confidence interval (95% CI) 1.34-4.56]; P = 0.004), and to have myopathy (OR 5.53 [95% CI 2.82-10.82]; P < 0.001), and sicca symptoms (OR 2.40 [95% CI 1.30-4.42]; P = 0.005), even after adjustment for potential confounders. Baseline features that were associated with the future development of severe GI dysfunction included male sex (hazard ratio [HR] 2.99 [95% CI 1.53-5.84]; P = 0.001) and myopathy (HR 5.08 [95% CI 2.21-11.67]; P < 0.001).Conclusion. Distinct clinical features are present in SSc patients who are at risk of developing severe GI dysmotility. This finding is not only important clinically but also suggests that a unique pathologic process is at work in these patients.