Weng Chenghua, Ding Zongnan, Zhou Yiqun, Yang Qinyi, Xue Leixi, Zhang Lei, Wang Gang, Liu Zhichun
Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, 215000, Jiangsu, China.
Rheumatol Ther. 2023 Jun;10(3):635-648. doi: 10.1007/s40744-023-00540-6. Epub 2023 Feb 18.
Interstitial lung disease (ILD) is a common complication of dermatomyositis (DM) and one of the main risk factors for poor prognosis in DM patients. The aim of this study was to reveal the clinical characteristics of DM patients with ILD.
Clinical data from the Second Affiliated Hospital of Soochow University were used to conduct a retrospective case-control study. Univariate and multivariate logistic regression analysis were performed to identify risk factors for ILD in DM.
A total of 78 DM patients were included in this study, including 38 DM patients with ILD and 40 DM patients without ILD. Compared with patients without ILD, patients with ILD were older (59.6 vs. 51.2 years, P = 0.004), and had higher rates of clinically amyopathic DM (CADM) (45 vs. 20%, P = 0.019), Gottron's papules (76 vs. 53%, P = 0.028), mechanic's hands (13 vs. 0%, P = 0.018), myocardial involvement (29 vs. 8%, P = 0.014), and higher positive rates of anti-SSA/Ro52 (74 vs. 20%, P < 0.001) and anti-melanoma differentiation-associated gene-5 (MDA5) (24 vs. 8%, P = 0.048) antibodies, while albumin (ALB) (34.5 vs. 38.0 g/l, P = 0.006), prognostic nutritional index (PNI) (40.3 vs. 44.7, P = 0.013), the rates of muscle weakness (45 vs. 73%, P = 0.013) and heliotrope rash (50 vs. 80%, P = 0.005) were lower. In addition, the five patients who died were all DM patients with ILD (13 vs. 0%, P = 0.018). Multivariate logistic regression showed that old age (odds ratio [OR] = 1.119, 95% confidence interval [CI] = 1.028-1.217, P = 0.009), Gottron's papules (OR = 8.302, 95% CI = 1.275-54.064, P = 0.027) and anti-SSA/Ro52 (OR = 24.320, 95% CI = 4.102-144.204, P < 0.001) were independent risk factors for ILD in DM.
DM patients with ILD usually present with older age, higher rates of CADM, Gottron's papules, mechanic's hands, myocardial involvement, higher positive rates of anti-MDA5 and anti-SSA/Ro52 antibodies, lower ALB, PNI, and lower rates of muscle weakness and heliotrope rash. Old age, Gottron's papules, and anti-SSA/Ro52 were independent risk factors for ILD in DM.
间质性肺病（ILD）是皮肌炎（DM）的常见并发症，也是DM患者预后不良的主要危险因素之一。本研究旨在揭示合并ILD的DM患者的临床特征。
利用苏州大学附属第二医院的临床数据进行回顾性病例对照研究。采用单因素和多因素逻辑回归分析确定DM患者发生ILD的危险因素。
本研究共纳入78例DM患者，其中38例合并ILD，40例未合并ILD。与未合并ILD的患者相比，合并ILD的患者年龄更大（59.6岁对51.2岁，P = 0.004），临床无肌病性DM（CADM）发生率更高（45%对20%，P = 0.019），Gottron丘疹发生率更高（76%对53%，P = 0.028），技工手发生率更高（13%对0%，P = 0.018），心肌受累发生率更高（29%对8%，P = 0.014），抗SSA/Ro52抗体阳性率更高（74%对20%，P < 0.001），抗黑色素瘤分化相关基因5（MDA5）抗体阳性率更高（24%对8%，P = 0.048），而白蛋白（ALB）水平更低（34.5g/L对38.0g/L，P = 0.006），预后营养指数（PNI）更低（40.3对44.7，P = 0.013），肌无力发生率更低（45%对73%，P = 0.013），向阳疹发生率更低（50%对80%，P = 0.005）。此外，死亡的5例患者均为合并ILD的DM患者（13%对0%，P = 0.018）。多因素逻辑回归显示，年龄较大（比值比[OR]=1.119，95%置信区间[CI]=1.028 - 1.217，P = 0.009）、Gottron丘疹（OR = 8.302，95%CI = 1.275 - 54.064，P = 0.027）和抗SSA/Ro52（OR = 24.320，95%CI = 4.102 - 144.204，P < 0.001）是DM患者发生ILD的独立危险因素。
合并ILD的DM患者通常年龄较大，CADM、Gottron丘疹、技工手、心肌受累发生率更高，抗MDA5和抗SSA/Ro52抗体阳性率更高，ALB、PNI更低，肌无力和向阳疹发生率更低。年龄较大、Gottron丘疹和抗SSA/Ro52是DM患者发生ILD的独立危险因素。
