背景:皮肌炎(DM)是一种罕见的自身免疫性疾病,以独特的皮疹为特征,对称和进行性肌肉无力的肌肉炎症,和血清肌肉相关酶水平升高。DM可能影响参与吞咽的骨骼肌,导致吞咽困难,这会对个人的身心健康产生负面影响。尽管如此,对DM患者的吞咽困难了解甚少。本系统综述和荟萃分析旨在评估DM和青少年DM(JDM)患者吞咽困难的患病率和临床特征。
方法:系统搜索了四个电子数据库,直到2022年9月。包括对DM或JDM和吞咽困难患者的研究。计算所有纳入研究的合并患病率,并对吞咽困难的临床特点进行定性分析。
结果:纳入了3335例患者的39项研究。DM患者吞咽困难的总体合并患病率为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]),而突尼斯的患病率最低(14.3%[95%CI:-0.040,0.326]).此外,南美的患病率最高(47.0%[95%CI:0.401,0.538]),而非洲的患病率最低(14.3%[95%CI:-0.040,0.326])。DM和JDM患者的吞咽困难的特征是口咽和食管功能障碍。在运动方面主要有困难。
结论:我们的研究结果表明,吞咽困难影响1/3的DM或JDM患者。然而,文献中关于吞咽困难的诊断和治疗的文献不足.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。
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).
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.
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.
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.