Myofascia-dominant involvement on whole-body MRI as a risk factor for rapidly progressive interstitial lung disease in dermatomyositis
Myofascia-dominant involvement on whole-body MRI as a risk factor for rapidly progressive interstitial lung disease in dermatomyositis
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DOI：
10.1093/rheumatology/kez642
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发表时间：
2020-07-01
期刊：
影响因子：
5.5
通讯作者：
Atsumi, Tatsuya
中科院分区：
文献类型：
--
作者：
Karino, Kohei;Kono, Michihiro;Atsumi, Tatsuya
Objective.快速进展性间质性肺病（RPILD）是糖尿病患者死亡的主要原因。尽管临床无肌病性DM（CADM）代表RPILD的风险，但CADM患者的RPILD发生率差异很大。全身（WB）MRI可显示全身肌肉和肌筋膜受累。本研究的目的是探讨糖尿病患者发生RPILD的危险因素。这项回顾性研究包括41例在我院开始治疗前接受WB-MRI的DM患者。对42个肌群的肌肉和肌筋膜信号进行评分。计算肌筋膜/肌肉比率，并用于定义肌筋膜主导受累的相关性。RPILD定义为呼吸困难、低氧血症和影像学ILD/纤维化在呼吸系统疾病发作后3个月内恶化。41例患者中，17例为CADM，30例为ILD，其中10例为RPILD。包括CADM患者在内的所有患者在肌肉和肌筋膜中均显示异常信号强度（中位数评分分别为15和23）。肌肉信号积分与血清肌酸激酶水平呈正相关（r=0.714; P< 0.001）。RPILD患者的肌筋膜/肌肉比显著高于无RPILD患者（1.929 vs 1.200; P= 0.027）。Logistic回归分析显示，肌筋膜/肌肉比值增高是RPILD发生的独立危险因素。肌筋膜为主的参与定义和赞赏糖尿病患者使用WB-MRI。这可能是RPILD的危险因素之一。
Objective. Rapidly progressive interstitial lung disease (RPILD) is a major cause of death in patients with DM. Although clinically amyopathic DM (CADM) represents risk for RPILD, the incidence rate of RPILD in patients with CADM varies widely. Whole-body (WB) MRI can reveal involvement of systemic muscle and myofascia. The objective of this study was to explore the risk factors for RPILD in patients with DM using WB-MRI.Methods. This retrospective study comprised 41 patients with DM who underwent WB-MRI before the initiation of treatment in our hospital. Muscular and myofascial signals were scored on 42 muscular groups. The myofascia/muscle ratio was calculated and used to define the relevance of myofascia-dominant involvement. RPILD was defined as worsening of dyspnoea, hypoxaemia and radiographic ILD/fibrosis within 3 months from the onset of respiratory symptoms.Results. Among the 41 patients, 17 had CADM and 30 had ILD, including 10 patients with RPILD. All patients including those with CADM showed abnormal signal intensity in both muscle and myofascia (median score: 15 and 23, respectively). Muscle signal scores positively correlated with the serum creatine kinase level (r=0.714; P< 0.001). Patients with RPILD showed a significantly higher myofascia/muscle ratio than those without RPILD (1.929 vs 1.200; P= 0.027). Logistic regression analysis identified higher myofascia/muscle ratio as independent risk factors for developing RPILD.Conclusion. Myofascia-dominant involvement was defined and appreciated in patients with DM using WB-MRI. This may be one of the risk factors for RPILD.