Thigh muscle MRI in immune-mediated necrotising myopathy: extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity.
Thigh muscle MRI in immune-mediated necrotising myopathy: extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity.
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DOI：
10.1136/annrheumdis-2016-210198
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发表时间：
2017-04
影响因子：
27.4
通讯作者：
Christopher-Stine L
中科院分区：
文献类型：
--
作者：
Pinal-Fernandez I;Casal-Dominguez M;Carrino JA;Lahouti AH;Basharat P;Albayda J;Paik JJ;Ahlawat S;Danoff SK;Lloyd TE;Mammen AL;Christopher-Stine L
本研究的目的是确定免疫介导性坏死性肌病（IMNM）患者相对于其他炎症性肌病患者的肌肉受累模式，并比较具有不同自身抗体的IMNM患者。所有接受大腿MRI （tMRI）检查并符合IMNM、皮肌炎（DM）、多发性肌炎（PM）、包体体肌炎（IBM）或临床淀粉样病变DM （CADM）标准的约翰霍普金斯大学肌炎纵向队列受试者均被纳入研究。评估肌肉的肌内和筋膜水肿、萎缩和脂肪替代。采用单因素和多因素分析比较疾病亚组。将具有抗信号识别颗粒（SRP）自身抗体的IMNM患者与具有抗hmg - coa还原酶（HMGCR）自身抗体的IMNM患者进行比较。共纳入666名受试者（IMNM 101例，PM 176例，DM 219例，CADM 17例，IBM 153例）。与DM或PM相比，IMNM的特征是大腿肌肉水肿、萎缩和脂肪替代比例更高（p<0.01）。抗srp组IMNM患者的萎缩（19%,p=0.003）和脂肪替代（18%,p=0.04）高于抗hmgcr组。在IMNM中，肌肉异常尤其常见于侧旋肌群和臀肌群。筋膜受累在糖尿病中最为普遍。在IMNM和其他组中，肌肉组织的脂肪替代在病程早期就开始了。tMRI特征的最佳组合诊断IMNM的阳性预测值仅为55%。与DM或PM患者相比，IMNM的特征是更广泛的肌肉受累。抗srp阳性患者比抗hmgcr阳性患者有更严重的肌肉受累。
The aims of this study were to define the pattern of muscle involvement in patients with immune-mediated necrotising myopathy (IMNM) relative to those with other inflammatory myopathies and to compare patients with IMNM with different autoantibodies. All Johns Hopkins Myositis Longitudinal Cohort subjects with a thigh MRI (tMRI) who fulfilled criteria for IMNM, dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) or clinically amyopathic DM (CADM) were included in the study. Muscles were assessed for intramuscular and fascial oedema, atrophy and fatty replacement. Disease subgroups were compared using univariate and multivariate analyses. Patients with IMNM with anti-signal recognition particle (SRP) autoantibodies were compared with those with IMNM with anti-HMG-CoA reductase (HMGCR) autoantibodies. The study included 666 subjects (101 IMNM, 176 PM, 219 DM, 17 CADM and 153 IBM). Compared with DM or PM, IMNM was characterised by a higher proportion of thigh muscles with oedema, atrophy and fatty replacement (p<0.01). Patients with IMNM with anti-SRP had more atrophy (19%, p=0.003) and fatty replacement (18%, p=0.04) than those with anti-HMGCR. In IMNM, muscle abnormalities were especially common in the lateral rotator and gluteal groups. Fascial involvement was most widespread in DM. Fatty replacement of muscle tissue began early during the course of disease in IMNM and the other groups. An optimal combination of tMRI features had only a 55% positive predictive value for diagnosing IMNM. Compared with patients with DM or PM, IMNM is characterised by more widespread muscle involvement. Anti-SRP-positive patients have more severe muscle involvement than anti-HMGCR-positive patients.