目的:分析并探讨RNP抗体在系统性硬化病中的临床意义。方法:收集自2004年以来在我院做过皮肤活检,并通过病理和临床确诊为系统性硬化病的62例住院患者。分为RNP+组(20例),SCL-70+组(20例),ENA-组(22例)。结果:RNP+组较其它两组关节痛、雷诺现象发生率明显升高(Plt;0.05),肌炎发生率亦有升高,指端病变发生率明显降低(Plt;0.05)。结论:通过对系统性硬化病患者体内部分典型抗体的研究,有利于临床医生判断不同抗体阳性的系统性硬化瘤患者病情的严重程度和预后。
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.