Oesophageal diameter is associated with severity but not progression of systemic sclerosis-associated interstitial lung disease
Oesophageal diameter is associated with severity but not progression of systemic sclerosis-associated interstitial lung disease
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DOI：
10.1111/resp.13309
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发表时间：
2018-10-01
期刊：
影响因子：
6.9
通讯作者：
Ryerson, Christopher J.
中科院分区：
文献类型：
--
作者：
Winstone, Tiffany A.;Hague, Cameron J.;Ryerson, Christopher J.
背景与目的食道疾病是否与系统性硬化性间质性肺疾病（SSc-ILD）的严重程度、进展或死亡率相关尚不清楚。方法采用高分辨率计算机断层扫描（HRCT）对145例SSc-ILD患者的纤维化评分、食管直径和裂孔疝的存在进行评分。纤维化不对称性计算为：（受影响最大的一侧-受影响最小的一侧）/（受影响最大的一侧+受影响最小的一侧）。重复测量分析采用混合效应模型。结果平均纤维化评分为8.6%，多数患者存在轻中度生理损害。食管直径每增加1厘米，纤维化评分升高1.8%，用力肺活量降低5.5% （FVC；未调整和调整分析的P < 0.001）。裂孔疝患者的纤维化评分比对照组高3.9%，校正分析显示差异持续存在（P = 0.001）。食管直径预测随后一年纤维化评分的恶化（P = 0.02），但在调整基线纤维化评分时则不然（P = 0.16）。食管直径与死亡率独立相关（P = 0.001）。食管直径与不对称疾病或大体吸进的放射学特征无关。结论食管直径和裂孔疝与SSc-ILD严重程度和死亡率独立相关，但与ILD进展或不对称疾病无关。食道疾病不太可能是SSc中ILD进展的重要驱动因素。我们对系统性硬化症相关间质性肺病（SSc-ILD）患者进行了一项迄今为止最全面的研究，以评估食道措施与SSc-ILD进展和死亡率的关系。我们发现食道疾病与SSc-ILD的严重程度和死亡率相关，但与ILD的进展或不对称性无关。看到相关的
Background and objectiveIt is unknown whether oesophageal disease is associated with systemic sclerosis-associated interstitial lung disease (SSc-ILD) severity, progression or mortality.MethodsHigh-resolution computed tomography (HRCT) scans from 145 SSc-ILD patients were scored for fibrosis score, oesophageal diameter and presence of hiatal hernia. Fibrosis asymmetry was calculated as: (most affected side - least affected side)/(most affected side + least affected side). Mixed effects models were used for repeated measures analyses.ResultsMean fibrosis score was 8.6%, and most patients had mild-to-moderate physiological impairment. Every 1 cm increase in oesophageal diameter was associated with 1.8% higher fibrosis score and 5.5% lower forced vital capacity (FVC; P 0.001 for unadjusted and adjusted analyses). Patients with hiatal hernia had 3.9% higher fibrosis score, with persistent differences on adjusted analysis (P = 0.001). Oesophageal diameter predicted worsening fibrosis score over the subsequent year (P = 0.02), but not when adjusting for baseline fibrosis score (P = 0.16). Oesophageal diameter was independently associated with mortality (P = 0.001). Oesophageal diameter was not associated with asymmetric disease or radiological features of gross aspiration.ConclusionOesophageal diameter and hiatal hernia are independently associated with SSc-ILD severity and mortality, but not with ILD progression or asymmetric disease. Oesophageal disease is unlikely to be a significant driver of ILD progression in SSc.We used a large cohort of patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) to conduct the most comprehensive study to date evaluating the association of oesophageal measures with progression and mortality of SSc-ILD. We show that oesophageal disease is associated with SSc-ILD severity and mortality, but not with ILD progression or asymmetry. See related