Xiao Fei, Chen Feilong, Li DongSheng, Zheng Songyuan, Liang Xiao, Wu Juan, Zhong JunYuan, Tan Xiangliang, Chen Rui, Zhu Junqing, Chen Shixian, Li Juan
Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou, China.
Ann Med. 2025 Dec;57(1):2440621. doi: 10.1080/07853890.2024.2440621. Epub 2024 Dec 19.
Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5DM-ILD) often leads to acute respiratory failure and endangers lives. This study quantitatively analysed chest high-resolution computed tomography (HRCT) images to assess MDA5DM-ILD and establish a risk prediction model for severe ILD within six months.
We developed a 'Standardized Threshold Ratio Analysis & Distribution' (STRAD) to analyse lung HRCT images. In this retrospective study, 51 patients with MDA5DM-ILD were included and divided into severe-ILD and non-severe-ILD groups based on the occurrence of acute respiratory failure within six months post-diagnosis of MDA5DM. The STRAD parameters, clinical indicators and treatments were compared between the two groups. Least absolute shrinkage and selection operator (LASSO) regression was used to select the optimal STRAD parameters. Multivariate analysis selected clinical factors to be further combined with STRAD to enhance the predictive performance of the final model (STRAD-Ro52 model).
Significant differences were observed between the two groups in STRAD parameters, anti-Ro52 antibody titers, presence of anti-Ro52 antibodies, age, ESR, ALB, Pa/FiO, IgM and IL-4 levels. The STRAD parameters were significantly correlated with demographic, inflammatory, organ function and immunological indicators. Lasso logistic regression analysis identified the -699 to -650 HU lung tissue proportion (%V7) as the optimal parameter for predicting severe ILD and S6·%V7, and the distribution of %V7 in the mid lungs was the optimal space parameter. Multifactorial regression of clinical indicators showed that the presence of anti-Ro52 antibodies was an independent risk factor for severe ILD, leading to the establishment of the STRAD-Ro52 model.
The STRAD-Ro52 model assists in identifying MDA5DM patients at risk of developing severe ILD within six months, further optimizing precise disease management and clinical research design.
抗黑色素瘤分化相关基因5阳性皮肌炎相关间质性肺病（MDA5DM-ILD）常导致急性呼吸衰竭并危及生命。本研究对胸部高分辨率计算机断层扫描（HRCT）图像进行定量分析，以评估MDA5DM-ILD，并建立6个月内严重ILD的风险预测模型。
我们开发了一种“标准化阈值比率分析与分布”（STRAD）方法来分析肺部HRCT图像。在这项回顾性研究中，纳入了51例MDA5DM-ILD患者，并根据MDA5DM诊断后6个月内急性呼吸衰竭的发生情况分为严重ILD组和非严重ILD组。比较两组的STRAD参数、临床指标和治疗情况。采用最小绝对收缩和选择算子（LASSO）回归来选择最佳的STRAD参数。多变量分析选择临床因素，进一步与STRAD相结合，以提高最终模型（STRAD-Ro52模型）的预测性能。
两组在STRAD参数、抗Ro52抗体滴度、抗Ro52抗体的存在、年龄、血沉、白蛋白、动脉血氧分压/吸入氧分数、IgM和IL-4水平方面存在显著差异。STRAD参数与人口统计学、炎症、器官功能和免疫指标显著相关。Lasso逻辑回归分析确定-699至-650 HU肺组织比例（%V7）为预测严重ILD的最佳参数，以及S6·%V7，且%V7在肺中部的分布为最佳空间参数。临床指标的多因素回归显示，抗Ro52抗体的存在是严重ILD的独立危险因素，从而建立了STRAD-Ro52模型。
STRAD-Ro52模型有助于识别在6个月内有发生严重ILD风险的MDA5DM患者，进一步优化精准疾病管理和临床研究设计。
