Service de Médecine interne, URM, CHU de Toulouse, France.
Service de Biostatistiques, Institut Universitaire du Cancer de Toulouse, Oncopôle, France.
Autoimmun Rev. 2018 Nov;17(11):1081-1089. doi: 10.1016/j.autrev.2018.05.010. Epub 2018 Sep 10.
The purpose of our study was to determine the prevalence and risk factors associated with malnutrition, and selenium (Se) and vitamin C (vitC) deficiencies in systemic sclerosis (SSc) patients.
We included adult SSc patients fulfilling the 2013 ACR/EULAR criteria from the Toulouse University Hospital cohort who underwent a micronutrient workup (including vitC, Se or thiamine levels) between 2011 and 2016.
82 patients were included, mostly women (76%), with a median age of 60 years. SSc was limited in 76% of the cases, with Scl-70 and centromere antibodies in 32% and 44%, respectively. Median disease duration was 7.4 years. Cardiac involvement was noticed in 19% and gastrointestinal tract in and 95%; 9% had pulmonary artery hypertension (PAH) and 63% had interstitial lung disease. Overt malnutrition was present in 14 (17%) patients. Micronutrient deficiencies included Se (35%), vitC (31%) and/or thiamine (6%). Malnourished patients had significantly a higher summed Medsger disease severity scales (7.5 vs. 5, P = .003), lower hemoglobin (10.6 vs. 12.9 g/dL, P < .0001) and vitC levels (3.6 vs. 10.6 mg/L, P = .003). Cardiac involvement was significantly associated with Se deficiency (OR 6.2, IC 95%[1.48-32.70], P = .05). The factors associated with vitC deficiency were malnutrition (OR 8.57, IC 95%[2.16-43.39], P = .003), modified Rodnan skin score ≤ 14 (OR 0.33, IC95[0.11-1], P = .05), PAH (27% in deficient vs. none in non-deficient patients, P = .0006) and esophagitis or Barrett's mucosa (OR 4.05, IC95[1.27-13.54], P = .02).
Se testing should be considered as soon as cardiac involvement is suspected. VitC testing should be considered in malnourished SSc patients, especially if skin involvement is extensive.
本研究旨在确定系统性硬化症（SSc）患者营养不良、硒（Se）和维生素 C（vitC）缺乏的患病率和相关风险因素。
我们纳入了 2013 年 ACR/EULAR 标准确诊的成年 SSc 患者，这些患者来自图卢兹大学医院队列，于 2011 年至 2016 年间接受了微量元素检测（包括 vitC、Se 或硫胺素水平）。
共纳入 82 例患者，主要为女性（76%），中位年龄 60 岁。76%的患者为局限性 SSc，32%和 44%的患者分别存在 Scl-70 和着丝粒抗体。中位疾病病程为 7.4 年。19%的患者存在心脏受累，95%的患者存在胃肠道受累；9%的患者患有肺动脉高压（PAH），63%的患者患有间质性肺病。14 例（17%）患者存在显性营养不良。微量营养素缺乏包括 Se（35%）、vitC（31%）和/或硫胺素（6%）。营养不良患者的 Medsger 疾病严重程度综合评分明显更高（7.5 比 5，P=0.003），血红蛋白（10.6 比 12.9 g/dL，P<0.0001）和 vitC 水平明显更低（3.6 比 10.6 mg/L，P=0.003）。心脏受累与 Se 缺乏显著相关（OR 6.2，95%CI [1.48-32.70]，P=0.05）。vitC 缺乏的相关因素包括营养不良（OR 8.57，95%CI [2.16-43.39]，P=0.003）、改良 Rodnan 皮肤评分≤14（OR 0.33，95%CI [0.11-1]，P=0.05）、PAH（缺乏 vitC 的患者中有 27%存在 PAH，而非缺乏 vitC 的患者中无一例存在 PAH，P=0.0006）和食管炎或 Barrett 黏膜（OR 4.05，95%CI [1.27-13.54]，P=0.02）。
一旦怀疑心脏受累，就应考虑进行 Se 检测。如果存在营养不良，特别是皮肤受累广泛，应考虑检测 vitC。
