David Geffen School of Medicine, University of California, Los Angeles.
Arthritis Care Res (Hoboken). 2023 Aug;75(8):1690-1697. doi: 10.1002/acr.25070. Epub 2023 Feb 7.
To investigate whether symptoms of gastroesophageal reflux disease and radiographic measures of esophageal dilation are associated with radiographic progression of systemic sclerosis-related interstitial lung disease (SSc-ILD).
Participants of the Scleroderma Lung Study II, which compared mycophenolate versus cyclophosphamide for SSc-ILD, completed the reflux domain of the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 at baseline. The diameter and area of the esophagus in the region of maximum dilation was measured by quantitative image analysis. Univariate and multivariable linear regression analyses were created to evaluate the relationship between these measures of esophageal involvement and progression of SSc-ILD over 2 years, based on the radiologic quantitative interstitial lung disease (QILD) and quantitative lung fibrosis (QLF) in the lobe of maximum involvement (LM). All multivariable models controlled for the treatment arm, baseline ILD severity, and proton-pump inhibitor use.
The baseline mean patient-reported reflux score was 0.57, indicating moderate reflux (n = 141). Baseline mean maximal esophageal diameter and area were 22 mm and 242 mm , respectively. Baseline reflux scores were significantly associated with the change in QLF-LM and QILD-LM in the univariate and multivariable models. Neither radiographic measure of esophageal dilation was associated with the change in radiographic measures of lung involvement.
Severity of reflux symptoms as measured by an SSc-specific questionnaire was independently associated with the change in the radiographic extent of ILD and fibrosis over 2 years in patients with SSc-ILD. Two objective measures of esophageal dilation were not associated with radiographic progression of ILD, highlighting the need for improved objective measures of esophageal dysfunction in SSc.
研究胃食管反流病症状和食管扩张的放射学指标是否与系统性硬化症相关间质性肺病（SSc-ILD）的放射学进展相关。
Scleroderma Lung Study II 的参与者比较了霉酚酸酯与环磷酰胺治疗 SSc-ILD，在基线时完成了加利福尼亚大学洛杉矶分校 Scleroderma 临床研究联盟胃肠道 2.0 的反流域。通过定量图像分析测量食管最大扩张部位的直径和面积。创建了单变量和多变量线性回归分析，以根据最大受累（LM）区域的放射学定量间质性肺病（QILD）和定量肺纤维化（QLF）来评估这些食管受累指标与 SSc-ILD 在 2 年内进展之间的关系。所有多变量模型均控制了治疗臂、基线ILD 严重程度和质子泵抑制剂的使用。
基线时患者报告的平均反流评分（n=141）为 0.57，表明存在中度反流。基线时食管最大直径和面积分别为 22 mm 和 242 mm。在单变量和多变量模型中，基线反流评分与 QLF-LM 和 QILD-LM 的变化显著相关。两种食管扩张的放射学指标均与肺受累的放射学指标的变化无关。
通过 SSc 特异性问卷测量的反流症状严重程度与 SSc-ILD 患者 2 年内 ILD 和纤维化的放射学范围的变化独立相关。两种食管扩张的客观测量指标与 ILD 的放射学进展无关，这突出表明需要在 SSc 中改进食管功能障碍的客观测量指标。
