Cheah Jenice X, Perin Jamie, Hughes Michael, Mecoli Christopher A, Paik Julie J, Hummers Laura K, Shah Ami A, McMahan Zsuzsanna H
Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Rheumatology (Oxford). 2025 May 1;64(5):2775-2782. doi: 10.1093/rheumatology/keae542.
The small bowel is affected in up to 50% of systemic sclerosis (SSc) patients, and some patients experience severe complications. Our aim was to use specific statistical methods to compare demographic and clinical features of SSc patients with and without abnormal small bowel to better characterize patients at risk for this complication.
SSc patients with gastrointestinal symptoms were prospectively enrolled and underwent a scintigraphy-based whole gut transit (WGT) study. A cross-sectional analysis was performed comparing clinical features between patients with and without abnormal small bowel transit by WGT. Univariate logistic regression models and multivariable models were used to examine the relationship between clinical features and abnormal small bowel transit.
Of 130 patients enrolled in this study, 22 had abnormal small bowel transit. SSc patients with abnormal small bowel transit were more likely to be male [odds ratio (OR) = 3.70; 95% CI: 1.07, 12.50; P = 0.038] and have more severe cardiac involvement (OR = 3.98; 95% CI: 1.10, 14.38; P = 0.035), while they were less likely to have sicca symptoms (OR = 0.30; 95% CI: 0.10, 0.94; P = 0.039). In multivariable analyses, sicca symptoms (OR = 0.28; 95% CI: 0.08, 0.96; P = 0.043) remained negatively associated with abnormal small bowel transit. Additionally, SSc patients with abnormal small bowel transit had higher mortality than patients with normal small bowel transit [hazard ratio (HR) = 4.57; 95% CI: 1.58, 13.24; P = 0.005].
These findings suggest that patients with abnormal small bowel transit in SSc are more likely to be male, have more severe cardiac involvement, higher mortality and fewer sicca symptoms. Recognizing this patient subgroup is essential for risk stratification and optimizing clinical care.
高达50%的系统性硬化症（SSc）患者小肠会受到影响，部分患者会出现严重并发症。我们的目的是运用特定统计方法比较有和无小肠异常的SSc患者的人口统计学和临床特征，以更好地明确有此并发症风险的患者特征。
前瞻性纳入有胃肠道症状的SSc患者，并进行基于闪烁扫描的全肠道转运（WGT）研究。通过横断面分析比较WGT显示有和无小肠转运异常的患者的临床特征。使用单变量逻辑回归模型和多变量模型来检验临床特征与小肠转运异常之间的关系。
本研究纳入的130例患者中，22例存在小肠转运异常。小肠转运异常的SSc患者更可能为男性[比值比（OR）=3.70；95%置信区间（CI）：1.07，12.50；P=0.038]且心脏受累更严重（OR=3.98；95%CI：1.10，14.38；P=0.035），而他们出现干燥症状的可能性较小（OR=0.30；95%CI：0.10，0.94；P=0.039）。在多变量分析中，干燥症状（OR=0.28；95%CI：0.08，0.96；P=0.043）仍与小肠转运异常呈负相关。此外，小肠转运异常的SSc患者的死亡率高于小肠转运正常的患者[风险比（HR）=4.57；95%CI：1.58，13.24；P=0.005]。
这些发现表明，SSc中小肠转运异常的患者更可能为男性，并伴有更严重的心脏受累、更高的死亡率以及更少的干燥症状。识别这一患者亚组对于风险分层和优化临床护理至关重要。
