Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China; Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
Semin Arthritis Rheum. 2023 Oct;62:152231. doi: 10.1016/j.semarthrit.2023.152231. Epub 2023 Jun 9.
To determine the prognostic factors of dermatomyositis with anti-melanoma differentiation-associated gene 5 (MDA5) antibody, a rare disease and often complicated by life-threatening, rapidly progressive interstitial lung disease.
Herein, we searched the Medline, Embase, and Cochrane Library databases and extracted studies published before August 23, 2022. Pooled analysis of hazard ratios (HRs) or odds ratios was used to identify prognostic factors for mortality among patients with anti-MDA5 antibody-positive dermatomyositis (MDA5+ DM).
Twenty-nine cohorts with 2,645 patients were included in this meta-analysis. Factors related to poor prognosis included old age (HR 1.54, 95% confidence interval (CI) 1.41-1.69, p < 0.01), male sex (HR 2.07, 95% CI 1.34-3.18, p < 0.01), rapidly progressive interstitial lung disease (RP-ILD) (HR 9.34, 95% CI 6.39-13.6, p < 0.01), high levels of ferritin (HR 1.05, 95% CI 1.01-1.08, p < 0.01), C-reactive protein (CRP) (HR 1.12, 95% CI 1.06-1.19, p < 0.01), creatine kinase (HR 1.05, 95% CI 1.03-1.07, p < 0.01), and lactate dehydrogenase (LDH) (HR 1.27, 95% CI 1.12-1.45, p < 0.01), whereas oxygen index (HR 0.990, 95% CI 0.988-0.992, p < 0.01), partial pressure of oxygen (HR 0.933, 95% CI 0.906-0.961, p < 0.01), forced vital capacity (HR 0.962, 95% CI 0.928-0.998, p = 0.038), and lymphocyte count (HR 0.421, 95% CI 0.282-0.629, p < 0.01) were associated with better outcomes.
Old age, male sex, hypoxemia, low forced vital capacity, lymphocytopenia, and high levels of ferritin, CRP, creatine kinase, and LDH are risk factors for mortality in patients with MDA5+ DM. However, a cautious interpretation of these results and further quality investigation are warranted.
确定抗黑色素瘤分化相关基因 5（MDA5）抗体阳性皮肌炎（MDA5+ DM）的预后因素，MDA5+ DM 是一种罕见疾病，常伴有危及生命的快速进展性间质性肺病。
本研究检索了 Medline、Embase 和 Cochrane Library 数据库，并提取了截至 2022 年 8 月 23 日发表的研究。使用风险比（HR）或优势比的汇总分析来确定 MDA5+ DM 患者死亡的预后因素。
本 meta 分析共纳入了 29 项队列研究，共 2645 例患者。与预后不良相关的因素包括年龄较大（HR 1.54，95%置信区间（CI）1.41-1.69，p < 0.01）、男性（HR 2.07，95%CI 1.34-3.18，p < 0.01）、快速进展性间质性肺病（RP-ILD）（HR 9.34，95%CI 6.39-13.6，p < 0.01）、铁蛋白水平较高（HR 1.05，95%CI 1.01-1.08，p < 0.01）、C 反应蛋白（CRP）（HR 1.12，95%CI 1.06-1.19，p < 0.01）、肌酸激酶（HR 1.05，95%CI 1.03-1.07，p < 0.01）和乳酸脱氢酶（LDH）（HR 1.27，95%CI 1.12-1.45，p < 0.01），而氧指数（HR 0.990，95%CI 0.988-0.992，p < 0.01）、氧分压（HR 0.933，95%CI 0.906-0.961，p < 0.01）、用力肺活量（HR 0.962，95%CI 0.928-0.998，p = 0.038）和淋巴细胞计数（HR 0.421，95%CI 0.282-0.629，p < 0.01）与较好的预后相关。
年龄较大、男性、低氧血症、用力肺活量低、淋巴细胞减少以及铁蛋白、CRP、肌酸激酶和 LDH 水平较高是 MDA5+ DM 患者死亡的危险因素。然而，需要谨慎解释这些结果并进一步进行质量调查。
