微量元素缺乏和营养不良对系统性硬化症的影响：队列研究和文献综述。

Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review.

机构信息

Service de Médecine interne, URM, CHU de Toulouse, France.

Service de Biostatistiques, Institut Universitaire du Cancer de Toulouse, Oncopôle, France.

出版信息

Autoimmun Rev. 2018 Nov;17(11):1081-1089. doi: 10.1016/j.autrev.2018.05.010. Epub 2018 Sep 10.

DOI:10.1016/j.autrev.2018.05.010

PMID:30213693

Abstract

OBJECTIVES

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

方法

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）。

结果

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）。