成人皮肌炎合并皮下钙化的临床特点及相关危险因素分析  

Clinical features and risk factors analysis in adult dermatomyositis with calcinosis

作　　者：江薇 杨阚波 李嗣钊[2] 李珊珊[2] 章璐[2] 卢昕[2] 王国春 Jiang Wei;Yang Kanbo;Li Sizhao;Li Shanshan;Zhang Lu;Lu Xin;Wang Guochun(Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China)

机构地区：[1]中国医学科学院协和医学院研究生院,北京100730 [2]中日友好医院风湿免疫科

出　　处：《中华风湿病学杂志》2018年第6期365-369,共5页Chinese Journal of Rheumatology

基　　金：国家自然科学基金（91542121,81571603）;首都卫生发展科研专项（2016-2-4063）;北京市科委课题（Z151100004015143）

摘　　要：目的探讨成人DM合并皮下钙化患者的临床特点及其发生钙化的相关危险因素。方法收集整理480例我院诊治的成人DM患者临床资料进行相关性分析，建立模型进行多因素Logistic回归分析研究DM发生皮下钙化的危险因素。结果480例DM患者发生皮下钙化者有22例，发生率为4．6％；钙化主要分布在四肢和躯干；皮下钙化组患者较非钙化组患者发病病程长C48（24，120）个月与10（3，24）个月，U=1993，P=0．000）]；钙化组患者出现肌无力（95．5％和76．9％，χ2=4．192，P=0．038）、脂膜炎（9．1％和0．4％，P=0．011）、甲周红斑（22．7％和5．9％，χ2=7．044，P=0．008）、皮肤破溃（50．0％和5．2％，χ2=55．767，P=0．000）、雷诺现象（27．5％和8．1％，χ2=3．956，P=0．047）的发生率较非钙化组高；皮下钙化组肌炎特异性抗体（MDA）5（31．8％和12．9％，χ2=4．851，P=0．028）和抗核基质蛋白抗体（NXP2）（27．3％和3．9％，χ2=19．416，P=0．000）阳性率较非钙化组高；多因素Logistie回归分析发现皮肤破溃[OR=31．585，95％CI（10．683，93．387），P=0．000]，NXP2抗体阳性[OR=10．899，95％CI（2．593，45．816），P=0．001]和发病病程[OR=1．105，95％CI（1．008，1．021），P=-0．000]是成人DM出现皮下钙化的危险因素。结论伴有皮下钙化患者的临床表现与无钙化患者明显不同，是一组DM独特的亚型；而长病程，皮肤溃疡和抗NXP2抗体阳性是患者发生皮下钙化的独立危险因素。Objective To identify clinical features and risk factors in adult dermatomyositis （DM） with calcinosis. Methods Four hundred and eighty patients clinical data were collected. The correlation between calcinosis and no calcinosis in adult DM were calculated by t test,χ2 test and Mann-whitney U test. Muhi- factor logistic regression model was established to analyze independent factors for adult DM with calcinosis. Results Calcinosis occurred in 22 cases among these 480 patients with DM. The incidence of adult DM with calcinosis was 4.6%. Calcinosis was most common in the extremities and trunks. Patients with calcinosis had a longer disease duration [48 （24, 120） months vs 10 （3, 24） months, U=1993, P=0.000）] and more myothenia （95.5% vs 76.9%, χ2=4.192, P=0.038）, panniculitis （9.1% vs 0.4%, P=0.011）, periungual erythematosus （22.7% vs 5.89%, χ2=7.044, P=0.008）, skin ulcer （50.0% vs 5.2%, χ2=55.767, P=0.000）, Raynaud＇s phenomenon （27.5% vs 8.1%,χ2=3.956, P=0.047）. The anti-NXP2 antibody （27.3% vs 3.9%,χ2=19.416, P=0.000） and anti- MDA5 antibody （31.8% vs 12.9%,χ2=4.851, P=0.028） were more frequently found in patients with calcinosis. Multi-factor logistic regression showed that anti-NXP2 antibody [OR=10.899, 95%CI （2.593, 45.816）, P=0.001], long diseases duration [OR=1.105, 95%CI（1.008, 1.021）, P=0.000] and skin ulcer [OR=31.585, 95%CI（10.683）, 93.387, P=0.000] were risk factors for adult DM with calcinosis. Conclusion The incidence of calcinosisis inadult DM is 4.5% in our cohort. Patients with calcinosis are adistinct clinical subset of adult DM. Long disease duration, skin ulcer and anti-NXP2 positive are independent risk factors for adult DM with calcinosis.

关 键 词：皮肌炎 危险因素 队列研究 皮下钙化 

分 类 号：R593.26[医药卫生—内科学]