多发性肌炎/皮肌炎患者肌炎特异性抗体与临床特征相关性分析  

Correlation analysis of myositis-specific antibodies and clinical features of polymyositis/dermatomyositis

作　　者：王雯雯 张培玉 王俊狄 吴华香[1] WANG Wenwen;ZHANG Peiyu;WANG Jundi;WU Huaxiang(Department of Rheumatology Immunology,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院风湿免疫科,杭州310009

出　　处：《浙江医学》2020年第16期1716-1720,1728,共6页Zhejiang Medical Journal

摘　　要：目的分析多发性肌炎/皮肌炎(PM/DM)患者肌炎特异性抗体(MSAs)分布特点及其与临床特征的相关性。方法回顾性分析2017年6月至2018年12月浙江大学医学院附属第二医院风湿免疫科收治的111例PM/DM患者的临床资料,包括患者的基本情况、临床表现、实验室检查及预后。采用Spearman相关对MSAs各抗体与临床特征的相关性进行分析。结果最常见的3种MSAs抗体为抗黑色素分化相关基因5(MDA5)抗体23例(20.7%),抗组氨酰tRNA合成酶(JO-1)抗体19例(17.1%),抗转录中介因子1-γ(TIF1-γ)抗体12例(10.8%)。肌炎相关性抗体(MAAs)中最常见RO-52阳性70例(63.06%),绝大部分与MSAs重叠。MDA5与皮疹、关节痛、发热、间质性肺炎、I型呼吸衰竭、白细胞减少呈正相关,与肌酸激酶升高呈负相关(均P<0.05)。JO-1与间质性肺炎呈正相关,与皮疹呈负相关(均P<0.05)。抗染色体-解旋酶-DNA结合蛋白(Mi-2)抗体、TIF1-γ与间质性肺炎均呈负相关(均P<0.05)。TIF1-γ与合并肿瘤呈正相关(P<0.05)。抗核基质蛋白2(NXP2)抗体与肌痛、肌无力、吞咽困难均呈正相关,与关节痛呈负相关(均P<0.05)。MDA5阳性、MDA5合并RO-52阳性与预后均呈负相关(均P<0.05)。MDA5合并RO-52阳性比单独MDA5阳性死亡的风险更大,J=518。结论PM/DM患者的MSAs抗体阳性率高,肌炎抗体检查有助于疾病诊断。不同MSAs抗体与临床特征相关,MSAs有助于判断疾病的临床表现和预后。Objective To analysis of relationship of myositis-specific antibodies(MSAs)with clinical characteristics of polymyositis/dermatomyositis(PM/DM).Methods The clinical data and laboratory findings of 111 patients with PM/DM were collected.The correlation of MSAs and clinical characteristics of patients was analyzed by spearman method using R language(RStudio 1.1.456).Results The detective rates of anti-melanoma differentiation-associated gene 5(MDA5)antibody,anti-histone-tRNA synthetase(JO-1)antibody and anti-transcriptional intermediary factor 1-γ(TIF1-γ)antibody in PM/DM patients were 20.7%(23/111),17.1%(19/111)and 10.8%(12/111),respectively.RO-52 was the most common myositis-associated autoantibodies(MAAs),with the detective rate of 63.06%(70/111),and most of them overlapped with MSAs.MDA5 was positively correlated with rash,joint pain,fever,interstitial pneumonia,type I respiratory failure,and leukopenia,and negatively correlated with elevated creatine kinase(CK)(all P<0.05).JO-1 was positively correlated with interstitial pneumonia and negatively correlated with rash(P<0.05).Mi-2 and TIF1-γwere negatively correlated with interstitial pneumonia(P<0.05).TIF1-γwas positively correlated with comorbid tumors(P<0.05).Anti-nuclear matrix protein 2(NXP2)antibody was positively related to myalgia,myasthenia gravis,and dysphagia,and negatively related to joint pain(P<0.05).MDA5 positive was risk factors for death(P<0.05).MDA5-positive+RO-52-positive had a greater risk of death than MDA5-positive alone(J=518).Conclusion The positive rate of MSAs antibodies in patients with PM/DM is high,and the examination of myositis antibodies is helpful for the diagnosis of the diseases.MSAs antibodies are related to clinical characteristics and prognosis of patients.

关 键 词：肌炎特异性抗体 皮肌炎 多发性肌炎 临床特征 预后 

分 类 号：R593.26[医药卫生—内科学]