摘要
目的分析抗黑色素瘤细胞分化相关基因5(melanoma differentiation-associated gene 5,MDA5)阳性皮肌炎患者的临床特征和死亡危险因素。方法收集2017年8月—2022年8月于空军军医大学第二附属医院风湿免疫科就诊并住院的皮肌炎患者67例进行回顾性分析,其中包括34例MDA5阳性皮肌炎患者(阳性组)与33例MDA5阴性皮肌炎患者(对照组),分析其临床特点。根据患者临床结局再将阳性组分为病死组(8例)与生存组(26例),分析阳性组患者病死的危险因素。结果67例皮肌炎患者中,阳性组34例,对照组33例,中位年龄为52.00(20.00,85.00)岁。与对照组比较,阳性组更易出现关节炎、特征性皮疹和间质性肺病(χ^(2)=6.594、12.653、4.422,P=0.010、<0.001、0.035);WBC、淋巴细胞水平、TC和LDL-C(t=3.353、2.970、2.625、4.029,P=0.001、0.004、0.011、<0.001)减低;而ALT、AST、γ-谷氨酰转移酶、红细胞沉降率、IL-6升高占比和C3降低占比升高(t=2.202、2.772、4.304、5.235、8.232、4.536,P=0.028、0.006、<0.001、0.022、0.004、0.033)。多因素Logistic回归分析结果显示,淋巴细胞<0.55×10^(9)/L(OR=31.403,95%CI:1.648~598.438)、IL-6>30 pg/ml(OR=35.313,95%CI:1.526~817.279)和铁蛋白>1100μg/L(OR=24.323,95%CI:1.309~452.038)是阳性组患者病死的危险因素。结论MDA5阳性皮肌炎患者临床以关节炎和特征性皮疹多见,易合并肺间质病变,炎性指标高,病死率高。
Objective To analyze the clinical characteristics and risk factors for death in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis.Methods The clinical data of 67 dermatomyositis patients admitted to the Department of Rheumatology and Immunology between August 2017 and August 2022 was retrospectively analyzed,including 34 MDA5 positive dermatomyositis patients(positive group)and 33 MDA5 negative ones(control group),and their clinical characteristics were analyzed.According to the clinical outcomes of patients,the MDA5 positive group was again divided into a death group(8 cases)and a survival group(26 cases)before the risk factors for death were analyzed.Results Among the 67 patients with dermatomyositis,34 were in the positive group and 33 in the control group,with an average age of 52.00(20.00,85.00)years.Compared with the control group,the positive group was more vulnerable to arthritis(χ^(2)=6.594,P=0.010),characteristic rash(χ^(2)=12.653,P<0.001)and interstitial lung disease(χ^(2)=4.422,P=0.035).White blood cell levels(t=3.353,P=0.001),lymphocyte levels(t=2.970,P=0.004),total cholesterol levels(t=2.625,P=0.011),low density lipoprotein cholesterol levels(t=4.029,P<0.001)and C3 decreased(t=4.536,P=0.033).However,the levels of alanine aminotransferase(t=2.202,P=0.028),aspartate aminotransferase(t=2.772,P=0.006),andγ-glutamyltransferase(t=4.304,P<0.001),and the rate of erythrocyte sedimentation(t=5.235,P=0.022)were higher,so was IL-6(t=8.232,P=0.004),and the differences were statistically significant.Multivariate logistic regression analysis showed that lymphocytes<0.55×10^(9)/L(OR=31.403,95%CI:1.648~598.438),interleukin-6>30 pg/m(OR=35.313,95%CI:1.526~817.279),and ferritin>1100μg/L(OR=24.323,95%CI:1.309~452.038)were risk factors for death.Conclusion MDA5 positive patients with dermatomyositis are more susceptible to arthritis,characteristic rash and interstitial lung disease,with high inflammatory markers and high mortality.
作者
李珊
刘洁
LI Shan;LIU Jie(Department of Rheumatology and Immunology,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)
出处
《空军航空医学》
2024年第6期511-515,共5页
AVIATION MEDICINE OF AIR FORCE
关键词
皮肌炎
抗黑色素瘤细胞分化相关基因5
间质性肺病
危险因素
Dermatomyositis
Melanoma differentiation-associated gene 5
Interstitial lung disease
Risk factor
