Galindo-Feria Angeles Shunashy, Rojas-Serrano Jorge, Hinojosa-Azaola Andrea
From the *Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; and †Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
J Clin Rheumatol. 2016 Mar;22(2):51-6. doi: 10.1097/RHU.0000000000000365.
Factors associated with survival in patients with idiopathic inflammatory myopathies are heterogeneous.
This study aimed to describe clinical and prognostic factors associated with survival in Mexican patients with idiopathic inflammatory myopathies.
Patients with dermatomyositis (DM) and polymyositis (PM) seen at a tertiary care center from 1985 to 2012 were included. Demographic and clinical characteristics, comorbidities, treatment, and the time to death were recorded. Patients with juvenile DM were excluded. Univariate and multivariate analyses were performed to identify factors associated with mortality.
A total of 264 patients with DM and 69 patients with PM were studied. Patients with DM had lower levels of creatine phosphokinase, less cumulative dose of prednisone, higher frequency of dysphagia, and no difference in frequency of interstitial lung disease compared with patients with PM. Patients with DM had lower survival during the first 4 years of disease (80%; 95% confidence interval [CI], 0.74-0.85 vs 89%; 95% CI, 0.78-0.95; P = 0.03 log-rank). Respiratory failure due to pulmonary infection was the main cause of death in patients with DM; miscellaneous causes were responsible for death in patients with PM. Muscular strength (hazard ratio [HR], 0.48; 95% CI, 0.27-0.83; P = 0.01), platelet count (HR, 0.98; 95% CI, 0.98-0.99; P = 0.002), as well as ever use of methotrexate (HR, 0.21; 95% CI, 0.07-0.65; P = 0.007) and azathioprine (HR, 0.21; 95% CI, 0.06-0.68; P = 0.009) were independent factors associated with mortality in patients with DM; in those with PM, only cancer was associated (HR, 8.0; 95% CI, 1.4-43.9; P = 0.01).
Patients with DM had lower survival during the first 4 years of disease than patients with PM. Factors associated with mortality differed in both groups.
特发性炎性肌病患者的生存相关因素具有异质性。
本研究旨在描述墨西哥特发性炎性肌病患者的临床及预后相关因素。
纳入1985年至2012年在一家三级医疗中心就诊的皮肌炎（DM）和多发性肌炎（PM）患者。记录人口统计学和临床特征、合并症、治疗情况及死亡时间。排除青少年DM患者。进行单因素和多因素分析以确定与死亡率相关的因素。
共研究了264例DM患者和69例PM患者。与PM患者相比，DM患者的肌酸磷酸激酶水平较低、泼尼松累积剂量较少、吞咽困难发生率较高，间质性肺病发生率无差异。DM患者在疾病的前4年生存率较低（80%；95%置信区间[CI]，0.74 - 0.85 vs 89%；95% CI，0.78 - 0.95；P = 0.03对数秩检验）。肺部感染导致的呼吸衰竭是DM患者的主要死亡原因；PM患者的死亡原因则是多种其他原因。肌肉力量（风险比[HR]，0.48；95% CI，0.27 - 0.83；P = 0.01）、血小板计数（HR，0.98；95% CI，0.98 - 0.99；P = 0.002），以及曾使用甲氨蝶呤（HR，0.21；95% CI，0.07 - 0.65；P = 0.007）和硫唑嘌呤（HR，0.21；95% CI，0.06 - 0.68；P = 0.009）是DM患者死亡率的独立相关因素；在PM患者中，只有癌症与之相关（HR，8.0；95% CI，1.4 - 43.9；P = 0.01）。
DM患者在疾病的前4年生存率低于PM患者。两组中与死亡率相关的因素有所不同。
