一项关于皮肌炎患者吞咽困难的患病率和临床特征的系统回顾和荟萃分析。
A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis.
机构信息
Department of Medicine, School of Clinical Medicine, Lee Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK.
出版信息
Neurogastroenterol Motil. 2023 Sep;35(9):e14572. doi: 10.1111/nmo.14572. Epub 2023 Apr 3.
BACKGROUND
Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle-associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well-being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta-analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM).
METHODS
Four electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed.
KEY RESULTS
Thirty-nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: -0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: -0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility.
CONCLUSIONS & INFERENCES: Our findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.
背景
皮肌炎（DM）是一种罕见的自身免疫性疾病，其特征为独特的皮疹、肌肉炎症伴对称性进行性肌无力以及肌肉相关酶水平升高。DM 可能会影响参与吞咽的骨骼肌，导致吞咽困难，从而对个体的身心健康产生负面影响。尽管如此，DM 患者的吞咽困难仍未得到充分理解。本系统评价和荟萃分析旨在评估 DM 和青少年皮肌炎（JDM）患者吞咽困难的患病率和临床特征。
方法
系统检索了截至 2022 年 9 月的四个电子数据库，纳入了 DM 或 JDM 患者伴吞咽困难的研究。计算了所有纳入研究的总体患病率，并对吞咽困难的临床特征进行了定性分析。
主要结果
纳入了 39 项研究，共 3335 例患者。DM 患者的吞咽困难总患病率为 32.3%（95%CI：0.270，0.373），JDM 患者为 37.7%（95%CI：-0.031，0.785）。亚组分析显示，瑞典的患病率最高（66.7%[95%CI：0.289，1.044]），突尼斯的患病率最低（14.3%[95%CI：-0.040，0.326]）。此外，南美洲的患病率最高（47.0%[95%CI：0.401，0.538]），非洲的患病率最低（14.3%[95%CI：-0.040，0.326]）。DM 和 JDM 患者的吞咽困难表现为口咽和食管功能障碍，运动功能障碍为主。
结论
我们的研究结果表明，吞咽困难影响三分之一的 DM 或 JDM 患者。然而，文献中对吞咽困难的诊断和管理的记录不足。我们的结果强调需要使用临床和仪器评估来评估该人群的吞咽功能。
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