伴急性/亚急性间质性肺炎的临床无肌炎皮肌炎1年生存随访及危险因素分析  

One-year survival follow-up and risk factors analysis of clinically amyopathic dermatomyositis complicated by acute/subacute interstitial pneumonia

作　　者：郭强[1] 照日格图 吴美芳[1] 瞿爱华[3] 伍镝 叶霜[1] 鲍春德[1] 

机构地区：[1]上海交通大学医学院附属仁济医院风湿科,200001 [2]新疆自治区中医院 [3]江苏省常熟市中医院

出　　处：《上海医学》2009年第10期860-864,F0002,共6页Shanghai Medical Journal

摘　　要：目的了解伴发急性/亚急性间质性肺炎的临床无肌炎皮肌炎患者在不同治疗方案干预后1年的生存状况,并分析其危险因素。方法回顾性分析上海交通大学医学院附属仁济医院风湿科于1998年1月—2007年12月收治的伴发急性/亚急性间质性肺炎的成人临床无肌炎皮肌炎患者51例,追踪1年时的生存情况,采用Kaplan-Meier法比较不同治疗方案干预后1年的生存曲线,以COX回归分析该组患者的危险因素。结果Kaplan-Meier生存分析显示,联合激素+免疫抑制剂方案(95%CI值为8.10～10.69)优于单纯激素治疗方案(95%CI值为1.03～4.57,P<0.001)。与硫唑嘌呤+激素治疗方案(95%CI值为4.49～10.11)相比,应用环孢素+激素治疗方案的生存时间显著延长(95%CI值为8.27～12.66,P=0.045)。通过COX回归分析,筛选到的危险因素分别是治疗方案未联合使用免疫抑制剂(RR=2.73,P=0.001),间质性肺炎为急性型(RR=3.10,P=0.020),以及治疗初始已出现低氧血症(RR=6.17,P=0.005)。结论在现有各种药物治疗干预下伴急性/亚急性间质性肺炎的临床无肌炎皮肌炎预后仍不乐观,间质性肺炎的类型固然是预后的决定因素之一,但早期用药、联合激素与免疫抑制剂治疗能延长患者的生存时间,其中联合环孢素的治疗方案更佳。Objective To investigate the one-year survival status of patients with clinically amyopathic dermatomyositis complicated by acute/subacute interstitial pneumonia （CAMD-A/SIP） receiving different treatment regimens, and to analyze its risk factors. Methods Totally 51 hospitalized patients with CAMD-A/SIP who received treatment during Jan. 1998 to Dec. 2007 in the Shanghai Renji Hospital were retrospectively analyzed. Kaplan-Meier analysis was used to compare the one-year-survival curve of patients receiving different treatment regimes. COX regression was used to analyze risk factors of CAMD-A/SIP. Results Kaplan-Meier analysis showed that the one-year survival rate of patients receiving steroid alone （95% CI： 1.03--4.57） was significantly lower compared to those receiving steroid ＋ immunosuppresants （ 95 % CI ： 8.10-- 10.69, P〈0.001 ）. Compared with azathiaprJne alone （ 95 % CI ： 4.49-- 10.11 ）, cyclosporine （ 95 % CI ： 8.27-- 12.66） ＋ steroid achieved a significantly high survival rate （ P = 0. 045）. COX regression showed that regimes without immunosuppressants （RR=2.73,P= 0.001 ）, acute type of interstitial pneumonia （RR= 3.10, P= 0.020）, and lower pressure of oxygen （PO2） at the beginning of treatment （RR= 6.17, P= 0.005） were risk factors for CAMD-A/SIP. Conclusion The prognosis of CAMD-A/SIP is poor after treatment with existing regimes. Although the type of interstitial pneumonia is one of the decisive factors early intervention, combined regimes including steroid and immunosuppresants can also prolong the survival time, especially with the steroid cyclosporine regimes. （Shanghai Med J, 2009, 32： 860-864）

关 键 词：临床无肌炎皮肌炎 急性/亚急性间质性肺炎 生存分析 

分 类 号：R563.1[医药卫生—呼吸系统] R593.26[医药卫生—内科学]