Rheumatology Unit, University of Verona, Verona, Italy.
Respiratory Physiopathology Unit, University of Verona, Verona, Italy.
Clin Rheumatol. 2018 Apr;37(4):987-997. doi: 10.1007/s10067-017-3932-y. Epub 2017 Dec 1.
Systemic sclerosis (SSc) is an autoimmune disease which may lead to malnutrition. Previous studies have defined it with different criteria. No thorough evaluations of sarcopenia in SSc are available. The aim of the present study was to assess the prevalence and the potential association of malnutrition and sarcopenia in a large cohort of SSc cases. A total of 141 SSc consecutive outpatients were enrolled. Body composition was analyzed by densitometry. Malnutrition was defined according to recently published ESPEN criteria, whereas sarcopenia was diagnosed in patients with reduced skeletal muscle index. Malnutrition was diagnosed in 9.2% of patients (95% CI, 4.4-14.0%). Malnourished patients had worse gastrointestinal symptoms according to UCLA SCTC GIT 2.0 questionnaire (p = 0.007), lower physical activity (p = 0.028), longer disease duration (p = 0.019), worse predicted DLCO/VA and FVC (p = 0.009, respectively), worse disease severity according to Medsger severity score (p < 0.001), lower hemoglobin (p = 0.023), and fat-free mass (p < 0.001) and were more often sarcopenic (p < 0.001). In multivariate analysis, only FVC (p = 0.006) and disease severity (p = 0.003), in particular for the lungs (p = 0.013), were confirmed to be worse in malnourished patients. Sarcopenia was diagnosed in 29\140 patients (20.7%; 95% CI, 14.0-27.4%); 11\29 were also malnourished. In multivariate analysis, sarcopenic patients had longer disease duration (p = 0.049), worse DLCO/VA (p = 0.002), and lung (p = 0.006) and skin (p = 0.014) involvement. In SSc, malnutrition defined with ESPEN criteria was found to be lower than previously reported. Sarcopenia was found to be somewhat common. Lung involvement was significantly associated with nutritional status and may not be explained only by muscle weakness.
系统性硬化症（SSc）是一种自身免疫性疾病，可能导致营养不良。以前的研究已经用不同的标准来定义它。目前还没有关于 SSc 中肌肉减少症的全面评估。本研究的目的是评估大量 SSc 病例中营养不良和肌肉减少症的患病率和潜在相关性。共纳入 141 例 SSc 连续门诊患者。通过密度仪分析身体成分。根据最近发表的 ESPEN 标准定义营养不良，而在骨骼肌指数降低的患者中诊断为肌肉减少症。9.2%的患者（95%CI，4.4-14.0%）被诊断为营养不良。根据 UCLA SCTC GIT 2.0 问卷，营养不良患者胃肠道症状更严重（p=0.007），体力活动减少（p=0.028），疾病持续时间更长（p=0.019），预计 DLCO/VA 和 FVC 更差（分别为 p=0.009），根据 Medsger 严重程度评分，疾病严重程度更差（p<0.001），血红蛋白（p=0.023）和无脂肪质量（p<0.001）更低，肌肉减少症更常见（p<0.001）。在多变量分析中，仅 FVC（p=0.006）和疾病严重程度（p=0.003），特别是肺（p=0.013），被证实营养不良患者更差。29/140 例（20.7%；95%CI，14.0-27.4%）患者被诊断为肌肉减少症；其中 11/29 例也营养不良。在多变量分析中，肌肉减少症患者疾病持续时间更长（p=0.049），DLCO/VA 更差（p=0.002），肺（p=0.006）和皮肤（p=0.014）受累更严重。在 SSc 中，用 ESPEN 标准定义的营养不良低于以前的报告。肌肉减少症也比较常见。肺受累与营养状况显著相关，不能仅用肌肉无力来解释。
