Kishaba Tomoo, Yano Hiroyuki, Itagane Masaki, Sudo Ko, Nagano Hiroaki, Kinjo Mitsuyo
Department of Respiratory Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
Division of Rheumatology, Department of Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
J Thorac Dis. 2024 Jul 30;16(7):4229-4237. doi: 10.21037/jtd-23-1736. Epub 2024 Jul 3.
Polymyositis/dermatomyositis (PM/DM) patients often develop interstitial lung disease (ILD), which can lead to relapse despite anti-inflammatory treatments. This study aims to elucidate the clinical characteristics of relapses in PM/DM-associated ILD patients.
We gathered clinical data, including laboratory results, pulmonary function tests, chest high-resolution computed tomography findings from patients treated at Okinawa Chubu Hospital between January 1, 2010 and December 31, 2018.
We identified a total of 74 patients, comprising 21 men and 53 women. Among them, 38 patients remained relapse-free with maintenance therapy, while 36 experienced relapses despite immunosuppressive management. We followed these patients until June 30, 2023, and 13 patients died. The median survival period was 51.4 months (range, 0.3-214 months). When comparing clinical variables, relapsed patients tended to be younger (49.9 64.1 years), reported myalgia and rash more frequently (63.9% 28.9% and 61.15% 21.1%, respectively). In terms of laboratory findings, lactate dehydrogenase (LDH) levels were higher in relapsed patients (613±464 381±203 U/L). Radiological findings showed that ground glass opacity (GGO) was more prevalent in relapsed patients (58.3% 16.7%). A Cox-proportional hazards model for relapse demonstrated that serum LDH [hazard ratio (HR) 1.005, 95% confidence interval (CI): 1.000-1.009, P=0.02] and GGO (HR 1.863, 95% CI: 1.103-3.147, P=0.02) were valuable predictors of relapse. Receiver operating characteristic curve analysis of serum LDH indicated that a threshold of 450 correctly classified relapse in PM/DM-associated ILD patients.
Serum LDH and GGO may serve as predictors of relapse in PM/DM-associated ILD patients.
多发性肌炎/皮肌炎（PM/DM）患者常并发间质性肺疾病（ILD），尽管进行了抗炎治疗，仍可能复发。本研究旨在阐明PM/DM相关ILD患者复发的临床特征。
我们收集了2010年1月1日至2018年12月31日在冲绳中部医院接受治疗的患者的临床数据，包括实验室检查结果、肺功能测试、胸部高分辨率计算机断层扫描结果。
我们共纳入74例患者，其中男性21例，女性53例。其中，38例患者通过维持治疗未复发，而36例患者尽管接受了免疫抑制治疗仍复发。我们对这些患者进行随访至2023年6月30日，13例患者死亡。中位生存期为51.4个月（范围：0.3 - 214个月）。比较临床变量时，复发患者往往更年轻（49.9 ± 64.1岁），肌痛和皮疹的报告频率更高（分别为63.9% ± 28.9%和61.15% ± 21.1%）。在实验室检查结果方面，复发患者的乳酸脱氢酶（LDH）水平更高（613±464 ± 381±203 U/L）。影像学检查结果显示，磨玻璃影（GGO）在复发患者中更为普遍（58.3% ± 16.7%）。复发的Cox比例风险模型表明，血清LDH [风险比（HR）1.005，95%置信区间（CI）：1.000 - 1.009，P = 0.02]和GGO（HR 1.863，95% CI：1.103 - 3.147，P = 0.02）是复发的有价值预测指标。血清LDH的受试者工作特征曲线分析表明，450的阈值可正确分类PM/DM相关ILD患者的复发情况。
血清LDH和GGO可能作为PM/DM相关ILD患者复发的预测指标。
