Department of Environmental Immuno-Dermatology, Yokohama City University School of Medicine, Yokohama, Japan.
J Dermatol. 2011 Oct;38(10):973-9. doi: 10.1111/j.1346-8138.2011.01262.x. Epub 2011 Aug 26.
Dermatomyositis (DM) is an idiopathic systemic inflammatory disease that is often accompanied by interstitial lung disease (ILD) or internal malignancy. New autoantibodies, anti-clinically amyopathic dermatomyositis 140 (anti-CADM-140) antibody (Ab) and anti-155/140 Ab, as well as anti-aminoacyl-tRNA synthetase (anti-ARS) Ab and anti-Mi-2 Ab, have been discovered and their utility indicated. However, the association between these autoantibodies and the clinical characteristics of DM is not fully understood, and it is unclear whether anti-155/140 Ab is "specific" to DM patients with internal malignancy. Therefore, we analyzed 55 DM patients and 18 non-DM patients with malignancy to evaluate the clinical characteristics, especially skin manifestations, in association with DM-specific autoantibodies detected by immunoprecipitation. Six patients (11%) had anti-CADM-140 Ab, nine (16%) had anti-155/140 Ab, eight (15%) had anti-ARS Ab and six (11%) had anti-Mi-2 Ab. The frequency of DM patients positive for any type of autoantibody was 53%. Among the 20 DM patients with ILD, three (15%) had both anti-CADM-140 Ab and rapidly progressive ILD, and required intensive therapy (P < 0.05). ILD found in anti-ARS Ab-positive patients did not progress rapidly. The prevalence of muscle involvement in patients with anti-CADM-140 Ab was 83%. Among the 18 DM patients with internal malignancy, four (22%) had anti-155/140 Ab, and internal malignancy was found in four cases (44%) of nine anti-155/140 Ab-positive patients. None of the non-DM patients with malignancy were positive for anti-155/140 Ab. In conclusion, the results of the present study indicate that anti-155/140 Ab is specific to DM patients with internal malignancy and that we may be able to predict prognosis of ILD and the presence of malignancy to some extent, suggesting that examination of autoantibodies in DM patients is clinically very useful. However, further investigation is needed because several findings differ from those of previous reports.
皮肌炎（DM）是一种特发性全身性炎症性疾病，常伴有间质性肺病（ILD）或内脏恶性肿瘤。新的自身抗体，抗临床无肌病性皮肌炎 140（抗 CADM-140）抗体（Ab）和抗 155/140 Ab，以及抗氨酰-tRNA 合成酶（抗 ARS）Ab 和抗 Mi-2 Ab，已经被发现并表明其具有一定的临床应用价值。然而，这些自身抗体与 DM 患者的临床特征之间的关系尚未完全阐明，并且不清楚抗 155/140 Ab 是否“特异性”存在于伴内脏恶性肿瘤的 DM 患者中。因此，我们分析了 55 例 DM 患者和 18 例非 DM 恶性肿瘤患者，通过免疫沉淀法检测到 DM 特异性自身抗体，评估与 DM 相关的临床特征，尤其是皮肤表现。6 例（11%）患者存在抗 CADM-140 Ab，9 例（16%）患者存在抗 155/140 Ab，8 例（15%）患者存在抗 ARS Ab，6 例（11%）患者存在抗 Mi-2 Ab。任何类型自身抗体阳性的 DM 患者频率为 53%。在 20 例伴ILD 的 DM 患者中，3 例（15%）存在抗 CADM-140 Ab 且伴有快速进展性ILD，需要强化治疗（P＜0.05）。抗 ARS Ab 阳性患者的ILD 无进展迅速。抗 CADM-140 Ab 阳性患者的肌肉受累发生率为 83%。在 18 例伴内脏恶性肿瘤的 DM 患者中，4 例（22%）存在抗 155/140 Ab，9 例抗 155/140 Ab 阳性患者中有 4 例（44%）发现了内脏恶性肿瘤。非 DM 恶性肿瘤患者无一例存在抗 155/140 Ab。总之，本研究结果表明，抗 155/140 Ab 是伴内脏恶性肿瘤的 DM 患者的特异性自身抗体，我们可能能够在一定程度上预测ILD 的预后和恶性肿瘤的存在，提示在 DM 患者中检查自身抗体具有重要的临床意义。但是，需要进一步的研究，因为一些研究结果与以往的报道有所不同。
