Xie M M, Yan X, Li H, Ding J J, Gui X H, Liu Y, Wang Y S, Chen Z Y, Cai H R
Department of Respiratory Medicine, Drum Tower, Clinical Medical College of Nanjing Medical University, Nanjing 210008, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2018 Aug 12;41(8):616-621. doi: 10.3760/cma.j.issn.1001-0939.2018.08.009.
To investigate the profile and clinical significance of myositis-specific antibody spectrum (MSAs) in patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD). Sera from 74 patients with PM/DM-ILD, 29 patients with SLE and 32 healthy controls were collected and Euroline Autoimmune Inflammatory Myopathies 16 Ag kit was used for detecting MSAs . The clinical data of all patients were collected from medical records. Statistical analysis was performed using One-way ANOVA, -test, rank sum test, χ(2) test or Fisher's exact test. The overall detection rate of MSAs in 74 patients with PM/DM-ILD was 86.5%, significantly higher than that in patients with SLE and healthy controls (χ(2)=66.24, 69.85, <0.01). According to the diagnostic criteria of PM/DM, 18 of 74 patients were definitely diagnosed, 11 were preliminarily diagnosed and 45 were suspected, in which the detection rate of MSA was 83.3%, 90.9% and 86.7%, respectively .The detection rates of MSAs in 17 PM-ILD and 57 DM-ILD were 82.4% and 87.7% respectively. The anti-ARS and anti-MDA5 were the two most common subtypes of MSAs in patients with PM/DM-ILD, the positive rates being 59.5% and 25.7%, respectively . The incidence of CADM, acute/subacute ILD and 90-day mortality in the anti-MDA5 positive group (χ(2)=12.945, 23.203, 26.434, <0.05) was significantly higher than those of the anti-ARS group and the MSA-negative group, while the incidence of helitrope rash, V-rash, fever was significantly higher than the anti-ARS positive group (χ(2)=11.462, 5.895, 10.609, <0.05). The incidence of muscle weakness in anti-Jo-1 group was significantly higher than that in the non-Jo-1 antibody group (χ(2)=3.991, <0.05), while other clinical features were not statistically significant between the anti-Jo-1 and the non-Jo-1 anti-ARS positive groups (>0.05). The detection rate and accuracy of MSAs in polymyositis/dermatomyositis with ILD was very high, which was useful for early diagnosis of the disease, and severity and prognosis assessment. It is strongly recommended that MSAs should be detected in patients with clinical suspicion of PM/DM-associated interstitial lung diseases.
探讨多发性肌炎/皮肌炎相关间质性肺疾病（PM/DM-ILD）患者中肌炎特异性抗体谱（MSAs）的特征及临床意义。收集74例PM/DM-ILD患者、29例系统性红斑狼疮（SLE）患者及32例健康对照者的血清，采用Euroline自身免疫性炎性肌病16抗原试剂盒检测MSAs。所有患者的临床资料均从病历中收集。采用单因素方差分析、t检验、秩和检验、χ²检验或Fisher确切概率法进行统计学分析。74例PM/DM-ILD患者中MSAs的总体检出率为86.5%，显著高于SLE患者及健康对照者（χ²=66.24、69.85，P<0.01）。根据PM/DM诊断标准，74例患者中确诊18例，初诊11例，疑似45例，其中MSA检出率分别为83.3%、90.9%和86.7%。17例PM-ILD和57例DM-ILD中MSAs的检出率分别为82.4%和87.7%。抗ARS和抗MDA5是PM/DM-ILD患者中最常见的两种MSA亚型，阳性率分别为59.5%和25.7%。抗MDA5阳性组中临床无肌病性皮肌炎（CADM）、急性/亚急性ILD及90天死亡率（χ²=12.945、23.203、26.434，P<0.05）显著高于抗ARS组及MSA阴性组，而向阳疹、V字疹、发热的发生率显著高于抗ARS阳性组（χ²=11.462、5.895、10.609，P<0.05）。抗Jo-1组肌无力发生率显著高于非Jo-1抗体组（χ²=3.991，P<0.05），而抗Jo-1与非Jo-1抗ARS阳性组之间其他临床特征差异无统计学意义（P>0.05）。MSAs在伴ILD的多发性肌炎/皮肌炎中的检出率及准确性很高，有助于疾病的早期诊断、病情严重程度及预后评估。强烈建议对临床怀疑为PM/DM相关间质性肺疾病的患者检测MSAs。
