Villadsen G E, Storkholm J, Zachariae H, Hendel L, Bendtsen F, Gregersen H
Department of Medicine V, Surgical Gastroenterology L and Radiology R, Section AKH, Aarhus University Hospital, Aarhus, Denmark.
Neurogastroenterol Motil. 2001 Jun;13(3):199-210. doi: 10.1046/j.1365-2982.2001.00259.x.
The aim of the present study was to correlate the severity of oesophageal motor dysfunction with the severity of cutaneous disease in systemic sclerosis (SS). Patients were divided into three groups based on the degree of skin involvement: type I, acrosclerosis distal to the wrist; type II, scleroderma extending above the wrist in proximal direction; type III, diffuse cutaneous systemic sclerosis. Impedance planimetry employing distensions with pressures up to 5 kPa with the concomitant measurement of oesophageal cross-sectional area (CSA) was used in combination with standard oesophageal manometry. Measurements were made at 7 and 15 cm above the lower oesophageal sphincter (LOS). Thirty patients (16 type I, six type II and eight type III patients) and 23 normal controls were included. LOS pressure was lower in SS patients than in normal patients, with the lowest values in type III. The CSAs were higher in SS patients than in controls at both sites (P < 0.001). The CSAs at the distal site were highest in type III, as compared to type I and II (P < 0.03). The CSA at the highest induced pressure (5.0 kPa) was 613 +/- 45, 719 +/- 79, and 808 +/- 115 mm2 in types I, II and III, respectively. No differences in CSA were found at the proximal site between the three types of SS. The distensibility did not differ between SS and normal patients at the distal site. The distensibility was lowest in SS patients (P < 0.001) at the proximal distension site. The distensibility did not vary with the type of SS at either site. Significant differences in contraction frequency of the secondary peristalsis as function of wall tension were demonstrated between the SS patients and controls at the distal site (P < 0.05). No differences were found at the proximal site. The contraction frequency and amplitude at the distal and proximal sites did not differ among the three types. In conclusion for most parameters studied, SS patients differed from normal patients. Among SS types, the most pronounced changes were found in type III.
本研究的目的是关联系统性硬化症（SS）患者食管运动功能障碍的严重程度与皮肤疾病的严重程度。根据皮肤受累程度将患者分为三组：I型，腕部远端的肢端硬化症；II型，硬皮病向近端延伸至腕部以上；III型，弥漫性皮肤系统性硬化症。采用压力高达5 kPa的扩张并同时测量食管横截面积（CSA）的阻抗平面测量法与标准食管测压法联合使用。测量在下食管括约肌（LOS）上方7 cm和15 cm处进行。纳入了30例患者（16例I型、6例II型和8例III型患者）和23名正常对照者。SS患者的LOS压力低于正常患者，III型患者的LOS压力最低。在两个部位，SS患者的CSA均高于对照者（P < 0.001）。与I型和II型相比，III型患者远端部位的CSA最高（P < 0.03）。在最高诱导压力（5.0 kPa）下，I型、II型和III型患者的CSA分别为613±45、719±79和808±115 mm²。三种类型的SS患者近端部位的CSA无差异。在远端部位，SS患者与正常患者的扩张性无差异。在近端扩张部位，SS患者的扩张性最低（P < 0.001）。在两个部位，扩张性均不随SS类型而变化。在远端部位，SS患者与对照者之间的继发性蠕动收缩频率随壁张力的变化存在显著差异（P < 0.05）。在近端部位未发现差异。三个类型在远端和近端部位的收缩频率和幅度无差异。总之，对于大多数研究参数，SS患者与正常患者不同。在SS各类型中，III型的变化最为明显。
