摘要
目的分析多发性肌炎/皮肌炎(PM/DM)患者肌炎特异性抗体(MSAs)分布特点及其与临床特征的相关性。方法回顾性分析2017年6月至2018年12月浙江大学医学院附属第二医院风湿免疫科收治的111例PM/DM患者的临床资料,包括患者的基本情况、临床表现、实验室检查及预后。采用Spearman相关对MSAs各抗体与临床特征的相关性进行分析。结果最常见的3种MSAs抗体为抗黑色素分化相关基因5(MDA5)抗体23例(20.7%),抗组氨酰tRNA合成酶(JO-1)抗体19例(17.1%),抗转录中介因子1-γ(TIF1-γ)抗体12例(10.8%)。肌炎相关性抗体(MAAs)中最常见RO-52阳性70例(63.06%),绝大部分与MSAs重叠。MDA5与皮疹、关节痛、发热、间质性肺炎、I型呼吸衰竭、白细胞减少呈正相关,与肌酸激酶升高呈负相关(均P<0.05)。JO-1与间质性肺炎呈正相关,与皮疹呈负相关(均P<0.05)。抗染色体-解旋酶-DNA结合蛋白(Mi-2)抗体、TIF1-γ与间质性肺炎均呈负相关(均P<0.05)。TIF1-γ与合并肿瘤呈正相关(P<0.05)。抗核基质蛋白2(NXP2)抗体与肌痛、肌无力、吞咽困难均呈正相关,与关节痛呈负相关(均P<0.05)。MDA5阳性、MDA5合并RO-52阳性与预后均呈负相关(均P<0.05)。MDA5合并RO-52阳性比单独MDA5阳性死亡的风险更大,J=518。结论PM/DM患者的MSAs抗体阳性率高,肌炎抗体检查有助于疾病诊断。不同MSAs抗体与临床特征相关,MSAs有助于判断疾病的临床表现和预后。
Objective To analysis of relationship of myositis-specific antibodies(MSAs)with clinical characteristics of polymyositis/dermatomyositis(PM/DM).Methods The clinical data and laboratory findings of 111 patients with PM/DM were collected.The correlation of MSAs and clinical characteristics of patients was analyzed by spearman method using R language(RStudio 1.1.456).Results The detective rates of anti-melanoma differentiation-associated gene 5(MDA5)antibody,anti-histone-tRNA synthetase(JO-1)antibody and anti-transcriptional intermediary factor 1-γ(TIF1-γ)antibody in PM/DM patients were 20.7%(23/111),17.1%(19/111)and 10.8%(12/111),respectively.RO-52 was the most common myositis-associated autoantibodies(MAAs),with the detective rate of 63.06%(70/111),and most of them overlapped with MSAs.MDA5 was positively correlated with rash,joint pain,fever,interstitial pneumonia,type I respiratory failure,and leukopenia,and negatively correlated with elevated creatine kinase(CK)(all P<0.05).JO-1 was positively correlated with interstitial pneumonia and negatively correlated with rash(P<0.05).Mi-2 and TIF1-γwere negatively correlated with interstitial pneumonia(P<0.05).TIF1-γwas positively correlated with comorbid tumors(P<0.05).Anti-nuclear matrix protein 2(NXP2)antibody was positively related to myalgia,myasthenia gravis,and dysphagia,and negatively related to joint pain(P<0.05).MDA5 positive was risk factors for death(P<0.05).MDA5-positive+RO-52-positive had a greater risk of death than MDA5-positive alone(J=518).Conclusion The positive rate of MSAs antibodies in patients with PM/DM is high,and the examination of myositis antibodies is helpful for the diagnosis of the diseases.MSAs antibodies are related to clinical characteristics and prognosis of patients.
作者
王雯雯
张培玉
王俊狄
吴华香
WANG Wenwen;ZHANG Peiyu;WANG Jundi;WU Huaxiang(Department of Rheumatology Immunology,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《浙江医学》
CAS
2020年第16期1716-1720,1728,共6页
Zhejiang Medical Journal
关键词
肌炎特异性抗体
皮肌炎
多发性肌炎
临床特征
预后
Myositis specific antibody
Dermatomyositis
Polymyositis
Clinical features
Prognosis
