Gastroesophageal Reflux and Pulmonary Fibrosis in Scleroderma
Gastroesophageal Reflux and Pulmonary Fibrosis in Scleroderma
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DOI：
10.1164/rccm.200808-1359oc
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发表时间：
2009-03-01
影响因子：
24.7
通讯作者：
Ghio, Massimo
中科院分区：
文献类型：
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作者：
Savarino, Edoardo;Bazzica, Marco;Ghio, Massimo
理由：系统性硬化症 (SSc) 患者的间质性肺疾病 (ILD) 与发病率和死亡率增加相关。胃食管反流 (GER) 被认为是 ILD 发病机制中的一个促成因素。 目的： 表征伴或不伴 ILD 的 SSc 患者的 GER（酸性和非酸性）。 方法： SSc 患者接受肺部高分辨率计算机断层扫描 (HRCT) 扫描和 24 小时阻抗 - pH 监测非质子泵抑制剂治疗。使用经过验证的 HRCT 评分评估肺纤维化的存在。反流监测参数包括酸性和非酸性反流发作的次数、反流物的近端迁移和远端食管酸暴露。除非另有说明，数据均以中位数（第 25-75 个百分位数）表示。 测量和主要结果：对 40 名连续 SSc 患者（35 名女性；平均年龄 53 岁，范围 24-71；15 名弥漫性 SSc 患者和 25 名局限性 SSc 患者）进行了研究； 18 名 (45%) SSc 患者患有肺纤维化（HRCT 评分 >= 7）。伴有 ILD 的 SSc 患者食管酸暴露较高（P < 0.01）（10.3 [7.5-15] vs. 5.2 [1.5-11]），胃酸反流次数较高（P < 0.01）（41 [31-58] vs. 19 [10-23]）和非酸反流（25 [20-35] vs. 17 [11-19]）发作次数和反流发作次数较多 (P < 0.01) 与 HRCT 评分正常的 SSc 患者相比，到达近端食管（42.5 [31-54] 对比 15 [8-22]）。肺纤维化评分（HRCT 评分）与远端食管 (r(2) = 0.637) 和近端食管 (r(2) = 0.644) 反流发作次数密切相关。 结论：伴 ILD 的 SSc 患者反流更严重（即更多的反流发作和更多的反流到达近端食管）。是否可以通过减少反流治疗来预防 SSc 患者发展为间质性肺病（ILD），尚需研究。
Rationale: Interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is associated with increased morbidity and mortality. Gastroesophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD.Objectives: To characterize GER (acid and nonacid) in patients with SSc with and without ILD.Methods: Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-hour impedance-pH monitoring off-proton pump inhibitor therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and nonacid reflux episodes, proximal migration of the refluxate, and distal esophageal acid exposure. Unless otherwise specified, data are presented as median (25th-75th percentile).Measurements and Main Results: Forty consecutive patients with SSc (35 female; mean age, 53 yr, range, 24-71; 15 patients with diffuse and 25 with limited SSc) were investigated; 18 (45%) patients with SSc had pulmonary fibrosis (HRCT score >= 7). Patients with SSc with ILD had higher (P < 0.01) esophageal acid exposure (10.3 [7.5-15] vs. 5.2 [1.5-11]), higher (P < 0.01) number of acid (41 [31-58] vs. 19 [10-23]) and nonacid (25 [20-35] vs. 17 [11-19]) reflux episodes, and higher (P < 0.01) number of reflux episodes reaching the proximal esophagus (42.5 [31-54] vs. 15 [8-22]) compared with patients with SSc with normal HRCT scores. Pulmonary fibrosis scores (HRCT score) correlated well with the number of reflux episodes in the distal (r(2) = 0.637) and proximal (r(2) = 0.644) esophagus.Conclusions: Patients with SSc with ILD have more severe reflux (i.e., more reflux episodes and more reflux reaching the proximal esophagus). Whether or not the development of ILD in patients with SSc can be prevented by reflux-reducing treatments needs to be investigated.