Zhou Meiju, Jiang Lichun, Nie Liuyan, Chen Ting, Zhang Ting, Sun Wenjia, Sutikno Joshua, Du Yan, Xue Jing
Department of Rheumatology, the Second Affiliated Hospital of Zhejiang University School of Medicine.
Department of Rheumatology, Zhejiang Hospital, Hangzhou.
Medicine (Baltimore). 2020 Aug 14;99(33):e21734. doi: 10.1097/MD.0000000000021734.
To compare clinical characteristics and identify long-term outcomes of Chinese patients with systemic sclerosis (SSc) with and without muscle involvement.We retrospectively investigated the medical records, laboratory results, and computed tomography images of 204 consecutive SSc patients. Kaplan-Meier analysis was performed to determine survival rates. Patients were allocated into groups with and without myopathy.The prevalence of myopathy was 21.6%. The myopathy group was more likely to develop diffuse cutaneous involvement (90.9% vs 56%, P = .006), interstitial lung disease (90% vs 56%, P < .001), digestive system involvement (56.7% vs 29.3%, P = .001), pulmonary hypertension (29.5% vs 10.5%, P = .004), and pericardial effusion (25% vs. 10%, P = .019). Patients with myopathy had lower single-breath diffusing capacity of the lung for carbon oxide (46.5 ± 11.1 vs 57.1 ± 13.4, P < .001).Further, the myopathy group has similar results in interstitial lung disease associated higher resolution computed tomography score (186.8 ± 64.5 vs 152.3 ± 45.5, P = .037), Valentini score for disease activity (3.4 ± 0.9 vs 2.0 ± 0.9, P < .001) and modified Rodnan total skin score (19.4 ± 6.1 vs 15.1 ± 7.7, P = .002), compared with non-myopathy group. Kaplan-Meier survival analysis revealed decreased overall survival rate of the myopathy group (P = .028).SSc Patients with myopathy had more severe clinical manifestations and higher disease activity compared with those without, which affected survival rates and indicated worse prognosis.
比较有和没有肌肉受累的中国系统性硬化症(SSc)患者的临床特征并确定其长期预后。我们回顾性研究了204例连续的SSc患者的病历、实验室检查结果和计算机断层扫描图像。采用Kaplan-Meier分析来确定生存率。患者被分为有肌病组和无肌病组。肌病的患病率为21.6%。肌病组更易出现弥漫性皮肤受累(90.9%对56%,P = 0.006)、间质性肺疾病(90%对56%,P < 0.001)、消化系统受累(56.7%对29.3%,P = 0.001)、肺动脉高压(29.5%对10.5%,P = 0.004)和心包积液(25%对10%,P = 0.019)。有肌病的患者肺一氧化碳单次呼吸弥散量较低(46.5±11.1对57.1±13.4,P < 0.001)。此外,与无肌病组相比,肌病组在间质性肺疾病相关的高分辨率计算机断层扫描评分(186.8±64.5对152.3±45.5,P = 0.037)、疾病活动度的瓦伦蒂尼评分(3.4±0.9对2.0±0.9,P < 0.001)和改良罗德南皮肤总评分(19.4±6.1对15.1±7.7,P = 0.002)方面有相似结果。Kaplan-Meier生存分析显示肌病组的总生存率降低(P = 0.028)。与无肌病的SSc患者相比,有肌病的患者临床表现更严重,疾病活动度更高,这影响了生存率并提示预后更差。