Predictive factors of rapidly progressive-interstitial lung disease in patients with clinically amyopathic dermatomyositis
Predictive factors of rapidly progressive-interstitial lung disease in patients with clinically amyopathic dermatomyositis
复制标题
临床无肌病性皮肌炎患者快速进展性间质性肺疾病的预测因素
DOI：
10.1007/s10067-015-3139-z
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发表时间：
2016-01-01
影响因子：
3.4
通讯作者：
Yang, P. T.
中科院分区：
文献类型：
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作者：
Xu, Y.;Yang, C. S.;Yang, P. T.
临床上无肌病性皮肌炎（CADM）是皮肌炎的一个独特的子集，表现出高发病率的肺部受累。本研究的目的是确定CADM患者发生快速进展性间质性肺病（RP-ILD）的风险因素，而不是黑色素瘤分化相关蛋白（MDA）-5。入组了40例CADM患者，其中11例患者发生RP-ILD。比较有无RP-ILD患者的临床特征和实验室检查结果。我们发现皮肤溃疡、CRP、血清铁蛋白、抗MDA 5抗体和淋巴细胞减少与ILD显著相关。多因素Logistic回归分析显示，抗MDA 5 Ab+、CRP升高、淋巴细胞计数降低是RP-ILD的独立危险因素，可为CADM患者RP-ILD的发生提供准确的预测指标。当从多元回归模型中去除抗-MDA 5 Ab+时，使用皮肤溃疡、血清铁蛋白升高和淋巴细胞计数降低也可以准确预测RP-ILD。除MDA-5外，其他临床特征，如皮肤溃疡、血清铁蛋白、淋巴细胞计数等也有助于预测CADM的预后。
Clinically amyopathic dermatomyositis (CADM) is a unique subset of dermatomyositis, showing a high incidence of lung involvements. The aim of this study is to identify risk factors, other than melanoma differentiation-associated protein (MDA)-5, for developing rapidly progressive-interstitial lung disease (RP-ILD) in patients with CADM. Forty CADM patients, in whom 11 patients developed RP-ILD, were enrolled. Clinical features and laboratory findings were compared between the patients with and without RP-ILD. We found that skin ulceration, CRP, serum ferritin, anti-MDA5 Ab, and lymphocytopenia were significantly associated with ILD. Multivariate logistic regression analysis indicated that anti-MDA5 Ab+, elevated CRP, and decreased counts of lymphocyte were independent risk factors for RP-ILD, which can provide a precise predict for RP-ILD in CADM patients. When anti-MDA5 Ab+was removed from the multivariate regression model, using skin ulcerations, elevated serum ferritin and decreased counts of lymphocyte can also precisely predict RP-ILD. Except for MDA-5, more commonly available clinical characteristics, such as skin ulcerations, serum ferritin, and count of lymphocyte may also help to predict prognosis in CADM.