Savarino Edoardo, Bazzica Marco, Zentilin Patrizia, Pohl Daniel, Parodi Andrea, Cittadini Giuseppe, Negrini Simone, Indiveri Francesco, Tutuian Radu, Savarino Vincenzo, Ghio Massimo
Division of Gastroenterology, University of Genoa, Genoa, Italy.
Am J Respir Crit Care Med. 2009 Mar 1;179(5):408-13. doi: 10.1164/rccm.200808-1359OC. Epub 2008 Dec 18.
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.
To characterize GER (acid and nonacid) in patients with SSc with and without ILD.
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).
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 >or= 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.
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.
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。
描述有或无ILD的SSc患者的GER（酸性和非酸性）情况。
SSc患者在停用质子泵抑制剂治疗的情况下接受肺部高分辨率计算机断层扫描（HRCT）和24小时阻抗 - pH监测。使用经过验证的HRCT评分评估肺纤维化的存在情况。反流监测参数包括酸性和非酸性反流发作次数、反流物的近端迁移以及远端食管酸暴露情况。除非另有说明，数据以中位数（第25 - 75百分位数）表示。
对40例连续的SSc患者（35例女性；平均年龄53岁；范围24 - 71岁；15例弥漫性SSc和25例局限性SSc）进行了研究；18例（45%）SSc患者有肺纤维化（HRCT评分≥7）。与HRCT评分正常的SSc患者相比，患有ILD的SSc患者有更高的（P < 0.01）食管酸暴露（10.3 [7.5 - 15] 对 5.2 [1.5 - 11]）、更高的（P < 0.01）酸性（41 [31 - 58] 对 19 [10 - 23]）和非酸性（25 [20 - 35] 对 17 [11 - 19]）反流发作次数，以及更高的（P < 0.01）到达近端食管的反流发作次数（42.5 [31 - 54] 对 15 [8 - 22]）。肺纤维化评分（HRCT评分）与远端（r² = 0.637）和近端（r² = 0.644）食管的反流发作次数密切相关。
患有ILD的SSc患者有更严重的反流（即更多的反流发作次数和更多的反流到达近端食管）。SSc患者的ILD发展是否可以通过减少反流的治疗来预防需要进一步研究。
