Coexistence of Anti-Ro52 Antibodies in Anti-MDA5 Antibody-Positive Dermatomyositis Is Highly Associated With Rapidly Progressive Interstitial Lung Disease and Mortality Risk
Coexistence of Anti-Ro52 Antibodies in Anti-MDA5 Antibody-Positive Dermatomyositis Is Highly Associated With Rapidly Progressive Interstitial Lung Disease and Mortality Risk
复制标题
DOI：
10.3899/jrheum.220139
复制
发表时间：
2023-02-01
影响因子：
3.9
通讯作者：
Tan, Wenfeng
中科院分区：
文献类型：
--
作者：
Lv, Chengyin;You, Hanxiao;Tan, Wenfeng
Objective.间质性肺疾病（ILD）是一种常见的肌外并发症，在抗黑色素瘤分化相关基因5抗体（抗-MDA 5+）阳性的皮肌炎（DM）患者中可导致显著的发病率和死亡率。本研究旨在探讨抗-Ro 52抗体与抗-MDA 5 + DM患者的临床特征和预后的关系。我们评估了246例抗MDA 5 + DM患者的队列。为了计算快速进展性ILD（RP-ILD）和死亡的风险比和95% CI，同时控制潜在混杂因素，将通过单变量考克斯回归分析选择的变量纳入采用逐步向前选择法的多变量考克斯回归模型中。双尾分析P < 0.05有统计学意义。共入组了246例抗MDA 5 + DM患者; 70例患者为男性，患者组的平均年龄为53.1（12.4）岁。64.2%（158/246）的患者存在抗Ro 52。抗Ro 52抗体阳性的抗MDA 5 + DM患者RP-ILD发生率较高（对数秩P < 0.001），死亡率较高（对数秩P = 0.01）。对于抗Ro 52阳性的抗MDA 5 + DM患者，病程短且炎症程度高的患者发生RP-ILD和死亡的风险增加。活动性皮疹的出现是死亡的独立保护因素。抗Ro 52抗体在抗MDA 5 + DM患者中高度流行，其共存与较高的RP-ILD发生率和死亡率相关。病程短、炎症增加、无皮疹的患者预后更差。
Objective. Interstitial lung disease (ILD) is a common extramuscular complication contributing to signifi-cant morbidity and mortality in patients with dermatomyositis (DM) who are positive for antimelanoma differentiation-associated gene 5 antibody (anti-MDA5+). We conducted this study to investigate the asso-ciation of anti-Ro52 antibodies with clinical characteristics and prognosis in patients with anti-MDA5+ DM.Methods. We assessed a cohort of 246 patients with anti-MDA5+ DM. To calculate hazard ratios and 95% CIs for rapidly progressive ILD (RP-ILD) and death while controlling for potential confounders, variables selected by univariate Cox regression analysis were included in a multivariate Cox regression model with the stepwise forward-selection method. A 2-tailed analysis with P < 0.05 was considered to be statistically significant.Results. A total of 246 patients with anti-MDA5+ DM were enrolled; 70 patients were male, and the patient group had an average age of 53.1 (12.4) years. Anti-Ro52 was present in 64.2% (158/246) patients. Patients with anti-MDA5+ DM who were positive for anti-Ro52 had a higher rate of RP-ILD (log-rank P < 0.001) and a higher mortality rate (log-rank P = 0.01). For patients with anti-MDA5+ DM who were positive for anti-Ro52, those with a short disease course and high inflammation were at increased risk of RP-ILD and death. The appearance of active rash was an independent protective factor of death.Conclusion. Anti-Ro52 antibodies were highly prevalent in patients with anti-MDA5+ DM, and their coex-istence correlated with a higher rate of RP-ILD and mortality. Patients with a short disease course, with increased inflammation, and without rash were more likely to have a poor prognosis.