Elevated Erythrocyte Sedimentation Rate Is Predictive of Interstitial Lung Disease and Mortality in Dermatomyositis: a Korean Retrospective Cohort Study.
Elevated Erythrocyte Sedimentation Rate Is Predictive of Interstitial Lung Disease and Mortality in Dermatomyositis: a Korean Retrospective Cohort Study.
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DOI：
10.3346/jkms.2016.31.3.389
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发表时间：
2016-03
影响因子：
4.5
通讯作者：
Park JK
中科院分区：
文献类型：
--
作者：
Go DJ;Lee EY;Lee EB;Song YW;Konig MF;Park JK
间质性肺病（ILD）是皮肌炎（DM）患者死亡的主要原因。本研究旨在探讨红细胞沉降率（ESR）作为ILD预测因子和DM患者死亡率预后标志物的实用性。对114例DM患者进行了检查，其中包括28例临床无肌病性DM（CADM）。根据高分辨率计算机断层扫描（HRCT）诊断ILD。然后研究ESR升高与肺损伤和死亡率之间的关系。114例DM患者中53例（46.5%）诊断为ILD。在53例合并ILD的DM患者中，2例（3.8%）被诊断为癌症，而在未合并ILD的DM患者中，24例（92.3%）被诊断为癌症（P < 0.001）。ILD患者的平均ESR（50.0 mm/小时）明显高于无ILD患者（29.0 mm/小时; P < 0.001）。ESR与用力肺活量（斯皮尔曼ρ =-0.303; P = 0.007）和一氧化碳弥散量（ρ =-0.319; P = 0.006）呈负相关。基线ESR ≥ 30 mm/h的DM患者死亡率显著高于基线ESR < 30 mm/h的患者（P = 0.002，logrank检验）。免疫抑制治疗后ESR持续升高的患者死亡率高于ESR正常的患者（P = 0.039，对数秩检验）。ESR升高与DM患者因呼吸衰竭导致的死亡率增加相关。因此，监测ESR应该是DM患者临床护理的一个组成部分。
Interstitial lung disease (ILD) is a major cause of death in patients with dermatomyositis (DM). This study was aimed to examine the utility of the erythrocyte sedimentation rate (ESR) as a predictor of ILD and prognostic marker of mortality in patients with DM. One hundred-and-fourteen patients with DM were examined, including 28 with clinically amyopathic DM (CADM). A diagnosis of ILD was made based on high resolution computed tomography (HRCT) scans. The association between elevated ESR and pulmonary impairment and mortality was then examined. ILD was diagnosed in 53 (46.5%) of 114 DM patients. Cancer was diagnosed in 2 (3.8%) of 53 DM patients with ILD and in 24 (92.3%) of those without ILD (P < 0.001). The median ESR (50.0 mm/hour) in patients with ILD was significantly higher than that in patients without ILD (29.0 mm/hour; P < 0.001). ESR was inversely correlated with forced vital capacity (Spearman ρ = - 0.303; P = 0.007) and carbon monoxide diffusing capacity (ρ = - 0.319; P = 0.006). DM patients with baseline ESR ≥ 30 mm/hour had significantly higher mortality than those with ESR < 30 mm/hour (P = 0.002, log-rank test). Patients with a persistently high ESR despite immunosuppressive therapy was associated with higher mortality than those with a normalized ESR (P = 0.039, log-rank test). Elevated ESR is associated with increased mortality in patients with DM due to respiratory failure. Thus, monitoring ESR should be an integral part of the clinical care of DM patients.