The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters.
The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters.
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DOI：
10.1111/nmo.12813
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发表时间：
2016-08
影响因子：
3.5
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
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作者：
Kimmel JN;Carlson DA;Hinchcliff M;Carns MA;Aren KA;Lee J;Pandolfino JE
我们的目的是使用高分辨率测压（HRM）评估Ssc相关全身表现与食管功能之间的相关性。确定了在2004年1月至2014年9月期间接受HRM的SSc患者，并根据芝加哥分类对HRM进行了分析。通过回顾性病历审查确定临床特征，并在调整年龄、性别、种族和SSC疾病持续时间的同时比较动力诊断。纳入79例患者（85%为女性，年龄25-77岁）。比较了无收缩性（AC，n = 40）、无效食管运动（IEM; n = 15）和正常运动（n = 19）患者的临床特征;其余5例患者符合其他运动诊断标准。通过改良的Rodnan皮肤评分（0-51）测量的皮肤受累严重程度不同：AC（校正平均值12.6），IEM（4.4），正常（4.3），p = 0.043。AC组（校正均值，FVC：70.3，DLCO：51.1）的肺功能检查[FVC和DLCO预测百分比]低于IEM组（FVC：92.0; DLCO：76.9）和正常运动性组（FVC：80.0; DLCO：67.2），p值0.057（FVC）和0.007（DLCO）。各组在SSC疾病持续时间、自身抗体或报告的吞咽困难或反流症状方面没有差异。在SSc患者中，HRM上食管收缩力缺失与皮肤病严重程度增加和肺功能恶化相关。可以考虑获得HRM以识别具有更严重食管功能障碍的SSc患者，以便在可能存在发病率和死亡率增加风险的患者中实施管理策略。
We aimed to evaluate the associations between SSc-related systemic manifestations and esophageal function using high-resolution manometry (HRM). Patients with SSc that had undergone HRM between 1/2004 and 9/2014 were identified and HRMs were analyzed according to the Chicago Classification. Clinical characteristics were identified via retrospective chart review and compared among motility diagnoses while adjusting for age, gender, race, and SSc-disease duration. 79 patients (85% female, ages 25–77) were included. Clinical characteristics were compared between patients with absent contractility (AC, n = 40), ineffective esophageal motility (IEM; n = 15), and normal motility (n = 19); the 5 remaining patients met criteria for other motility diagnoses. Groups differed in severity of skin involvement measured by the modified Rodnan skin score (0–51): AC (adjusted mean 12.6), IEM (4.4), normal (4.3), p = 0.043. Pulmonary function tests [percent predicted FVC and DLCO) were lower in AC (adjusted mean, FVC: 70.3, DLCO 51.1), than IEM (FVC: 92.0; DLCO: 76.9) and normal motility (FVC: 80.0; DLCO: 67.2), p-values 0.057 (FVC) and 0.007 (DLCO). Groups did not differ by SSc-disease duration, autoantibodies, or reported symptoms of dysphagia or reflux. In patients with SSc, absent esophageal contractility on HRM was associated with increased skin disease severity and worse lung function. Obtaining HRM to identify SSc patients with more severe esophageal dysfunction could be considered to enable implementation of management strategies in patients potentially at risk for increased morbidity and mortality.