Risk factors of interstitial lung diseases in clinically amyopathic dermatomyositis
Risk factors of interstitial lung diseases in clinically amyopathic dermatomyositis
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临床无肌病性皮肌炎发生间质性肺疾病的危险因素
DOI：
10.1097/cm9.0000000000000691
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发表时间：
2020-03-20
影响因子：
6.1
通讯作者：
Ye, Hua
中科院分区：
文献类型：
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作者：
Gan, Yu-Zhou;Zhang, Li-Hua;Ye, Hua
背景：临床上无肌病性皮肌炎（CADM）是一种独特的特发性炎症性肌病亚型，伴有间质性肺病（ILD）。患者预后不良与快速进展的ILD密切相关。本研究的目的是确定预测CADM中不同类型ILD的危险因素。方法收集108例住院CADM患者的临床资料，其中87例合并ILD。分析基线临床数据和实验室参数，包括肌炎特异性和相关抗体以及肿瘤相关抗原，以确定急性或亚急性间质性肺炎（A/SIP）和慢性间质性肺炎（CIP）的危险因素。结果87例CADM-ILD患者中，A/SIP 39例（36.1%），CIP 48例（44.4%）。有22例（20.4%）无症状ILD患者通过常规高分辨率计算机断层扫描检测到。CADM-ILD组细胞角蛋白-19片段（CYFRA 21 -1）显著高于无ILD组; A/SIP组癌胚抗原和神经元特异性烯醇化酶显著高于CIP组。A/SIP患者抗黑色素瘤分化相关基因5（MDA 5）阳性率较高，而CIP患者抗PL-12和抗Ro-52阳性率较高。Logistic回归分析显示CYFRA 21 -1升高是ILD的危险因素，抗MDA 5滴度升高提示A/SIP的可能性增加，抗Ro-52滴度升高也与CIP明显相关。结论CADM患者ILD患病率高。以前低估了无症状ILD。抗-MDA 5是A/SIP存在的危险因素，CYFRA 21 -1是ILD的危险因素。
Background Clinically amyopathic dermatomyositis (CADM) is a unique sub-type of idiopathic inflammatory myopathies with a high prevalence of interstitial lung disease (ILD). Poor prognosis of the patients was strongly associated with rapid progressive ILD. The aim of this study was to identify risk factors for prediction of different types of ILD in CADM. Methods In this study, data of 108 inpatients with CADM were collected, including 87 with ILD. The baseline clinical data and laboratory parameters, including myositis-specific and associated antibodies and tumor-associated antigens were analyzed to identify risk factors for acute or subacute interstitial pneumonitis (A/SIP) and chronic interstitial pneumonitis (CIP). Results In 87 patients with CADM-ILD, 39 (36.1%) were A/SIP, and 48 (44.4%) were CIP. There were 22 (20.4%) patients with asymptomatic ILD who were detected by routine high resolution computed tomography. Cytokeratin-19 fragment (CYFRA21-1) was significantly higher in CADM-ILD than that in CADM patients without ILD; carcinoembryonic antigen and neuron-specific enolase were significantly elevated in A/SIP than that in CIP. Patients with A/SIP had a higher positive rate of anti-melanoma differentiation-associated gene 5 (MDA5), while patients with CIP had a higher positive rate of anti PL-12 and anti-Ro-52. Logistic regression analysis indicated that elevation of CYFRA21-1 was a risk factor for ILD, higher titer of anti-MDA5 indicated increased likelihood for A/SIP, and higher titer of anti-Ro-52 was also clearly associated with CIP. Conclusions This study indicated that the prevalence of ILD was high in CADM. Asymptomatic ILD has been previously underestimated. Anti-MDA5 was a risk factor for the presence of A/SIP, and CYFRA21-1 was a risk factor for ILD.