Fujiki Youhei, Kotani Takuya, Isoda Kentaro, Ishida Takaaki, Shoda Takeshi, Yoshida Shuzo, Takeuchi Tohru, Makino Shigeki
a Department of Internal Medicine (IV) , Osaka Medical College , Takatsuki , Osaka , Japan.
b Department of Rheumatology, Internal Medicine , Yodogawa Christian Hospital , Osaka , Japan.
Mod Rheumatol. 2018 Jan;28(1):133-140. doi: 10.1080/14397595.2017.1318468. Epub 2017 May 11.
We retrospectively investigated clinical prognostic factors for interstitial pneumonia (IP) in anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive dermatomyositis (DM) patients.
Subjects comprised 18 patients with anti-MDA5 Ab-positive DM-IP (9 survivors; 9 deaths).
Initial serum albumin levels, ferritin levels, and ground-glass opacity (GGO) scores in the right middle lobes were significantly higher in the death group than in the survivor group (p = .033, .013, and .005, respectively). Initial alveolar-arterial oxygen gradient (P[A-a]O) was also higher in the death group than in the survivor group (p = .064). Initial serum ferritin, P[A-a]O, and right middle lobe GGO score were found to significantly relate to death. Survival rates after 24 weeks were significantly lower among patients with an initial ferritin level of ≥450 ng/mL (25%), P[A-a]O of ≥30 mmHg (31%), and a right middle lobe GGO score of ≥2 (11%) than each of the others (p = .006, .020, and .002, respectively).
An initial serum ferritin level of ≥450 ng/mL, P[A-a]O of ≥30 mmHg, and right middle lobe GGO score of ≥2 (GGO ≥5% of the lobe) were identified as poor prognostic factors for anti-MDA5 Ab-positive DM-IP patients.
我们回顾性研究了抗黑色素瘤分化相关基因5（MDA5）抗体（Ab）阳性皮肌炎（DM）患者间质性肺炎（IP）的临床预后因素。
研究对象包括18例抗MDA5 Ab阳性的DM-IP患者（9例存活；9例死亡）。
死亡组患者的初始血清白蛋白水平、铁蛋白水平以及右中叶磨玻璃影（GGO）评分显著高于存活组（p分别为0.033、0.013和0.005）。死亡组的初始肺泡-动脉氧分压差（P[A-a]O）也高于存活组（p = 0.064）。发现初始血清铁蛋白、P[A-a]O和右中叶GGO评分与死亡显著相关。初始铁蛋白水平≥450 ng/mL（25%）、P[A-a]O≥30 mmHg（31%）以及右中叶GGO评分≥2（11%）的患者24周后的生存率显著低于其他患者（p分别为0.006、0.020和0.002）。
初始血清铁蛋白水平≥450 ng/mL、P[A-a]O≥30 mmHg以及右中叶GGO评分≥2（GGO≥肺叶的5%）被确定为抗MDA5 Ab阳性DM-IP患者的不良预后因素。
