Chen Xixia, Lin Sang, Jin Qiwen, Zhang Lu, Jiang Wei, Lu Xin, Wang Guochun, Ge Yongpeng
Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China.
Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
J Inflamm Res. 2024 May 20;17:3247-3257. doi: 10.2147/JIR.S460702. eCollection 2024.
To investigate the prevalence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM).
A retrospective analysis was conducted in anti-MDA5+ DM patients diagnosed between January 2016 and March 2023. Patients with lower respiratory tract specimens were categorized into IPA+ and IPA- groups based on the presence of IPA and their clinical characteristics and prognoses then compared.
Of the 415 patients diagnosed with anti-MDA5+ DM, 28 cases had IPA (prevalence rate of 6.7%) with being the most common species. The patients were categorized into IPA+ (n=28) and IPA- (n=98) groups, with no significant age or gender-related differences (>0.05). The IPA+ group had a lower lymphocyte count, particularly the CD4+ T-cell count, and reduced serum albumin and higher serum ferritin levels ( all<0.05). An elevated bronchoalveolar lavage fluid (BALF) galactomannan level was found to be the sole independent risk factor for the occurrence of IPA (adjusted OR=2.191, =0.029) with a cut-off value of 0.585 and area under the curve of 0.779. The mortality rate in the IPA+ group was 25%. Compared to survivors, non-survivors in this group exhibited a higher incidence of rapidly progressive interstitial lung disease, lower lymphocyte counts, and increased co-infection with ( all<0.05).
IPA was not rare in patients with anti-MDA5+ DM, with elevated BALF galactomannan levels being an independent risk factor for IPA occurrence. Clinicians must exercise vigilance to identify patients exhibiting the aforementioned risk factors.
探讨抗黑色素瘤分化相关基因5阳性皮肌炎（抗MDA5+ DM）患者侵袭性肺曲霉病（IPA）的患病率、危险因素及预后。
对2016年1月至2023年3月期间诊断为抗MDA5+ DM的患者进行回顾性分析。将下呼吸道标本患者根据是否存在IPA分为IPA+组和IPA-组，然后比较其临床特征和预后。
在415例诊断为抗MDA5+ DM的患者中，28例患有IPA（患病率为6.7%）， 为最常见的菌种。患者分为IPA+组（n = 28）和IPA-组（n = 98），年龄和性别方面无显著差异（>0.05）。IPA+组淋巴细胞计数较低，尤其是CD4+ T细胞计数，血清白蛋白降低，血清铁蛋白水平升高（均<0.05）。支气管肺泡灌洗液（BALF）半乳甘露聚糖水平升高是IPA发生的唯一独立危险因素（校正OR = 2.191， = 0.029），临界值为0.585，曲线下面积为0.779。IPA+组死亡率为25%。与幸存者相比，该组非幸存者快速进展性间质性肺病发生率更高，淋巴细胞计数更低，合并 感染增加（均<0.05）。
抗MDA5+ DM患者中IPA并不罕见，BALF半乳甘露聚糖水平升高是IPA发生的独立危险因素。临床医生必须警惕识别表现出上述危险因素的患者。
