炎性肌病相关肺间质病变的预测指标和预后不良因素分析  

Predictive factors and unfavorable prognostic factorial analysis of interstitial lung disease in patients with inflammatory myopathy

作　　者：李然[1] 李向培[1] 厉小梅[1] 汪国生[1] 钱龙陶[1] 金辉[1] 马艳[1] 张宏[1] 

机构地区：[1]安徽医科大学附属省立医院风湿免疫科,合肥230001

出　　处：《中华医学杂志》2012年第33期2335-2338,共4页National Medical Journal of China

摘　　要：目的分析多发性肌炎和皮肌炎（PM／DM）一合并肺间质病变ILD的临床特点、预测指标和预后不良影响因素，为临床早期诊治提供依据。方法收集安徽医科大学附属省立医院风湿免疫科2001年8月至2011年8月244例PM／DM住院患者临床资料，回顾性分析PM／DM．ILD的临床特点、预测指标和预后不良影响因素。结果PM／DM—ILD患者临床上主要表现为干咳、活动时胸闷气促、下肺Velcro哕音。多因素非条件Logistic回归分析显示：无肌病皮肌炎（ADM）、关节痛／关节炎、发热、Gottron征可作为PM／DM患者出现ILD的预测指标，Fisher精确检验显示抗Jo－1抗体具有显著统计学意义。ADM、类Harmnan—Rich综合征型ILD是PM／DM-ILD患者严重的预后不良因素。早期应用大剂量糖皮质激素联合免疫抑制剂治疗是PM／DM-ILD的保护因素。结论ADM、关节痛／关节炎、发热、Gottron征、抗Jo—1抗体阳性可能是炎性肌病ILD的预测指标；ADM、类Hamman-Rich综合征型ILD是提示预后不良的重要因素，糖皮质激素联合免疫抑制剂治疗可改善PM／DM—ILD患者的预后。Objective To explore the clinical features, predictive factors and unfavourable prognostic factors of interstitial lung disease （ILD） in the patients with polymyositis and dermatomyositis （PM/DM） so as to provide rationales for early clinical diagnosis and treatment. Methods The medical records of 244 PM/DM patients from Department of Rheumatology ＆ hnmunology of Anhui Medical University Affiliated Provincial Hospital from August 2001 to August 2011 were reviewed to analyze the clinical features, predictive factors and unfavourable prognostic factors of ILD in PM/DM patients. Results The major clinical manifestations of PM/DM-ILD included dry cough, chest tightness and shortness of breath during activities and Velero rale in lower lung. Besides anti-Jo-1 antibody, multivariate unconditional Logistic regression analysis indicated that amyopathic dermatomyositis （ ADM ）, arthralgia/arthritis, fever and Gottron＇s sign were the predictive factors for the development of ILD in PM/DM patients. ADM and Hamman-Rieh-like pattern ILD were the poor prognostic factors while large dose glucocorticoids plus immunosuppressant therapy in the early time was a protective factor for PM/DM-ILD patients. Conclusion Some clinical features are the predictive factors for the development of ILD. ADM and Hamman-Rich-like pattern ILD are poor prognostic factors. Large dose glucocorticoids plus immunosuppressant therapy can significantly imorove the prognosis of PM/DM patients.

关 键 词：多发性肌炎 皮肌炎 肺疾病 间质性 预测 预后 

分 类 号：R593.26[医药卫生—内科学]