Marie I, Dominique S, Levesque H, Ducrotté P, Denis P, Hellot M F, Courtois H
Department of Internal Medicine, Centre Hospitalier Universitaire de Rouen-Boisguillaume, France.
Arthritis Rheum. 2001 Aug;45(4):346-54. doi: 10.1002/1529-0131(200108)45:4<346::AID-ART347>3.0.CO;2-L.
To assess whether esophageal manometric motor disturbances are associated with abnormalities consistent with interstitial lung disease (ILD) on both pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) scans in patients with systemic sclerosis (SSc), during initial evaluation and at 2 years followup.
Esophageal manometry, PFT, and HRCT scans were performed in 43 consecutive SSc patients. PFT and HRCT scan parameters were compared between patients with severe esophageal motor dysfunction (i.e., aperistalsis and decreased low esophageal sphincter pressure), patients with moderate esophageal motor dysfunction (hypoperistalsis), and patients without esophageal motor dysfunction on manometry.
During initial evaluation of SSc, patients with severe esophageal motor impairment, compared with those with moderate and without esophageal dysmotility, exhibited significantly decreased median values of diffusing capacity for carbon monoxide (DLco) (68% vs. 94% vs. 104%) and exhibited higher prevalence of evidence for ILD on HRCT scan (57% vs. 27% vs. 18%). At 2 years followup of SSc, patients with severe esophageal motor disturbances, compared with those without, had faster deterioration of DLco median values (-16% vs. +1%) and higher frequency of ILD on HRCT scan (70% vs. 25%).
Our series underscores a correlation between the degree of esophageal manometric motor disturbances and evidence for ILD on PFT and HRCT scan in SSc patients, suggesting that gastroesophageal reflux (GER) may be one of the contributing factors of ILD in SSc. Our findings further indicate that patients with severe esophageal impairment may require closer followup of lung parameters. In turn, it suggests that aggressive therapy of GER should be initiated in these SSc patients, as it may result in decreased deterioration of pulmonary function.
评估在系统性硬化症（SSc）患者的初始评估及2年随访期间，食管测压运动障碍是否与肺功能测试（PFT）及高分辨率计算机断层扫描（HRCT）扫描中符合间质性肺病（ILD）的异常情况相关。
对43例连续的SSc患者进行食管测压、PFT及HRCT扫描。比较食管运动功能严重障碍（即无蠕动及食管下括约肌压力降低）患者、食管运动功能中度障碍（蠕动减弱）患者及测压时无食管运动功能障碍患者的PFT和HRCT扫描参数。
在SSc的初始评估中，与中度及无食管运动障碍的患者相比，食管运动功能严重受损的患者一氧化碳弥散量（DLco）的中位数显著降低（分别为68%、94%和104%），且HRCT扫描显示ILD的患病率更高（分别为57%、27%和18%）。在SSc患者2年随访时，与无食管运动障碍的患者相比，食管运动功能严重障碍的患者DLco中位数的恶化速度更快（分别为-16%和+1%），HRCT扫描显示ILD的频率更高（分别为70%和25%）。
我们的系列研究强调了SSc患者食管测压运动障碍程度与PFT及HRCT扫描中ILD证据之间的相关性，提示胃食管反流（GER）可能是SSc中ILD的促成因素之一。我们的研究结果进一步表明，食管严重受损的患者可能需要更密切地随访肺部参数。反过来，这表明应在这些SSc患者中积极开展GER治疗，因为这可能会减缓肺功能的恶化。
