摘要
背景多发性肌炎(PM)/皮肌炎(DM)患者合并间质性肺疾病(ILD)是PM/DM主要致死因素,致死率在50%以上。目前国内对PM/DM合并ILD(PM/DM-ILD)临床特征及其影响因素的研究较少,且研究结果各不相同,尚缺乏有效证据证实哪些因素与PM/DM-ILD的发生有关。目的探讨PM/DM-ILD患者的临床特征及其影响因素。方法选取2014-01-01至2018-06-30于川北医学院附属医院诊治的119例PM/DM患者为研究对象,将其分为ILD组与非间质性肺疾病(NILD)组。比较两组一般情况、临床表现、实验室指标、肺部高分辨率CT(HRCT)结果及预后情况。采用逐步Logistic回归分析PM/DM-ILD的影响因素。结果ILD组患者年龄,关节炎首发、呼吸道症状首发、技工手、雷诺现象、干咳、咳痰、活动后气促、发热、关节炎发生率,红细胞沉降率(ESR)、球蛋白(GLOB)水平,抗Jo-1抗体阳性率高于NILD组,肌无力首发、肌酸激酶(CK)、CK/天冬氨酸氨基转移酶(AST)、清蛋白(ALB)水平低于NILD组(P<0.05)。ILD组中60例患者肺部HRCT以条索影(68.3%,41/60)、斑片影(68.3%,41/60)、网格状影(45.0%,27/60)、磨玻璃样(31.7%,19/60)、云絮状影(15.0%,9/60)、蜂窝状影(10.0%,6/60)等表现多见,可单独或同时出现;NILD组25.4%(15/59)的肺部HRCT也会出现少量条索影、斑片影、磨玻璃影等,但其病变部位、分布范围和病变程度均不满足ILD的影像学诊断标准,多属既往疾病的陈旧性改变。逐步Logistic回归分析结果显示,年龄、干咳、活动后气促、关节炎、GLOB、抗Jo-1抗体水平是PM/DM-ILD的影响因素(P<0.05)。ILD组患者重复住院率(χ^2=5.275,P=0.022)、肺部感染致重复住院率(P=0.010)高于NILD组。两组治疗效果比较,差异无统计学意义(χ^2=0.192,P=0.909)。结论年龄大,干咳、关节炎、活动后气促症状,血清抗Jo-1抗体阳性,GLOB水平升高是PM/DM-ILD发生的危险因素,对表现上述症状及血清学结果的高龄患者需密切检测其肺
Background Concurrent interstitial lung disease(ILD)in patients with polymyositis(PM)and dermatomyositis(DM)is a major cause of death with a fatality rate that exceeds 50%.However,there are currently few domestic studies on the clinical characteristics and related influencing factors of PM/DM combined with ILD(PM/DM-ILD) with different results,and there is still no valid evidence to confirm which factors are related to the occurrence of PM/DM-ILD.Objective To explore the clinical characteristics of PM/DM-ILD and its influencing factors.Methods A total of 119 patients with PM/DM who were treated in the Affiliated Hospital of North Sichuan Medical College from January 1,2014 to June 30,2018 were selected as subjects and divided into ILD group and non-interstitial lung disease(NILD)group.The general data,clinical symptoms,laboratory parameters,results of lung high-resolution CT(HRCT)and prognosis of the two groups were compared.Stepwise Logistic regression was used to analyze the influencing factors of PM/DM-ILD.Results The age,the first episode of arthritis,the first episode of respiratory symtom,mechanic’s hand,Reynolds phenomenon,dry cough,expectoration,post-exercise shortness of breath,fever,incidence of arthritis,erythrocyte sedimentation rate(ESR),globulin(GLOB) level,positive rate of anti-Jo-1 antibody of patients in ILD group were higher than those of patients in the NILD group,while the first episode of myasthenia,creatine kinase(CK),CK/glutamic-oxalacetic transaminase(AST),albumin(ALB) level of patients in ILD group were lower than those of patients in NILD group(P<0.05).Lung HRCT manifestations of 60 patients of the ILD group were mainly stripe shadow(68.3%,41/60),patchy shadow(68.3%,41/60),reticulate shadow(45.0%,27/60),ground glass opacity shadow(31.7%,19/60),cloud flocculent shadow(15.0%,9/60),and honeycomb shadow(10.0%,6/60),which could be seen alone or simultaneously.In NILD group,25.4%(15/59) of lung HRCT also showed a small amount of stripe shadow,patchy shadow and ground glass opacity shadow whi
作者
唐子猗
易婷
王聃
郑建雄
熊琴
张全波
青玉凤
TANG Ziyi;YI Ting;WANG Dan;ZHENG Jianxiong;XIONG Qin;ZHANG Quanbo;QING Yufeng(Department of Rheumatology and Immunology,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000, China;Department of Geriatrics,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Precision Medicine Key Laboratory of Sichuan Province & Precision Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中国全科医学》
CAS
北大核心
2019年第16期1960-1965,共6页
Chinese General Practice
基金
四川省属高校科研创新团队(14TD0021)
四川大学华西医院专职博士后研发基金资助项目(2018HXBH017)
关键词
多发性肌炎
皮肌炎
肺疾病
间质性
临床特征
影响因素分析
Polymyositis
Dermatomyositis
Lung disease,interstitial
Clinical characteristics
Root cause analysis
