Objective:To explore the clinical features of upper gastrointestinal tract involvement in systemic sclerosis (SSc),and analyze the influencing factors.Methods:Totally 52 hospitalized SSc patients in department of rheumatology of Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2011 to December 2015 were enrolled and divided into symptomatic group and asymptomatic group according to the gastrointestinal symptoms.All the cases underwent esophageal manometry,24 h esophageal pH monitoring,esophageal barium meal and (or) endoscopy.Meanwhile,data of esophageal manometry and 24 h esophageal pH monitoring of 18 outpatients with gastroesophageal reflux disease in the same period were collected.Results:In 52 SSc cases,there were 17 in asymptomatic group and 35 in symptomatic group.For skin changes,the incidences of finger skin sclerosis,finger tip damage and capillary dilation in symptomatic group were significantly higher than those in asymptomatic group (P＜0.05);the incidence of interstitial lung disease in symptomatic group was significantly higher than that in asymptomatic group (P＜0.05).There were no differences in levels of ANA,anticentromere antibody,anti Scl-70 antibody between two groups in SSc patients.For dynamic abnormalities,the UES relaxation rate was highest,and the LES pressure decay rate was the lowest in SSc patients.The Esophageal manometric parameters were not statistically different among three groups.The 24 h esophageal pH monitoring showed that DeMeester score in symptomatic group was significantly higher than that inasymptomatic group (P＜ 0.05).The positive rate of esophageal barium meal in symptomatic group was significantly higher than that in asymptomatic group (P ＜ 0.05),though the positive rate of gastroscopy was not statistically different.Conclusions:There are esophageal motility disorders and abnormal acid reflux in SSc patients with or without upper gastrointestinal symptoms,especially for those with upper gastrointestinal symptoms.For patients with long course of disease,finger skin sclerosis,finger tip damage,capillary dilation and interstitial lung disease,esophageal involvement should be alert.DeMeester score is helpful for early diagnosis.%目的:探讨系统性硬化症(systemic sclerosis,SSc)患者累及上消化道症状的临床特征,并分析其可能的影响因素.方法:纳入2011年1月至2015年12月于南京医科大学附属无锡市人民医院风湿免疫科住院的SSc患者52例,根据有无上消化道症状,分为症状组和无症状组.52例患者进行食管测压、24 h食管pH监测、食管钡餐和(或)内镜检查.收集同期在消化内科门诊确诊的18例胃食管反流病(GERD)患者的食管测压、24 h食管pH监测结果.结果:52例SSc患者中,无症状组17例、症状组35例.症状组皮肤改变中,手指皮肤硬化、指尖损害、毛细血管扩张发生率明显高于无症状组,差异有统计学意义(P＜0.05).SSc患者症状组肺间质病变发生率高于无症状组,差异有统计学意义(P＜0.05).SSc患者两组间抗核抗体(ANA)、抗着丝点抗体及抗Scl-70抗体差异均无统计学意义.SSc患者上消化道动力异常以上食管括约肌(UES)松弛率发生率最高,下食管括约肌(LES)压力降低发生率最低;3组间食管测压参数差异均无统计学意义.症状组24 h食管pH监测DeMeester积分高于无症状组,差异有统计学意义(P＜0.05).症状组食管钡餐结果阳性率高于无症状组,差异有统计学意义(P＜0.05).SSc两组间胃镜结果阳性率差异无统计学意义.结论:SSc有或无上消化道症状者均存在食管动力及酸反流异常,有症状者尤为明显;对于长病程、临床出现手指皮肤硬化、指尖损害、毛细血管扩张、肺间质病变的SSc患者要警惕病变累及食管;DeMeester积分有利于早期诊断.
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