肌炎特异性抗体亚型在多肌炎/皮肌炎患者临床特征及预后中的价值  

Association of myositis-specific antibody subtypes with clinical features and prognosis of patients with polymyositis/dermatomyosi-tis

作　　者：肖栋梅 王庭辉[1] 赵宝景[1] 袁青青 谢斌华 忻霞菲[1] 邬秀娣 XIAO Dongmei;WANG Tinghui;ZHAO Baojing;YUAN Qingqing;XIE Binhua;XIN Xiafei;WU Xiudi(Department of Rheumatology,Ningbo First Municipal Hospital,Ningbo 315010,China)

机构地区：[1]宁波市第一医院风湿免疫科,315010

出　　处：《浙江医学》2020年第21期2327-2334,I0003,共9页Zhejiang Medical Journal

摘　　要：目的探讨不同肌炎特异性抗体(MSAs)亚型与多肌炎(PM)/皮肌炎(DM)患者临床特征的相关性,及对患者预后的影响。方法收集2017年1月至2020年1月宁波市第一医院住院的PM/DM患者临床资料,包括11种MSAs亚型,与临床特征进行相关性分析,进一步logistic回归分析MSAs亚型是否为临床特征的独立影响因素,同时分析不同MSAs亚型PM/DM患者的Kaplan-Meier生存曲线,多因素Cox回归分析影响PM/DM患者预后的因素。结果137例PM/DM患者,DM131例,PM6例,MSAs总体阳性率77.37%,以抗组氨酰tRNA酶(Jo-1)抗体、抗黑色素分化相关基因5(MDA5)抗体、抗转录中介因子1-γ(TIF1-γ)抗体最多见,阳性率分别为19.71%、13.87%、15.33%,不同MSAs与PM/DM患者不同临床特征密切相关,抗TIF1-γ、抗NXP抗体阳性者易出现吞咽障碍(χ2=24.847,P<0.001;P=0.005),抗ARS、抗Jo-1抗体阳性者易出现肌痛(χ2=4.314、7.146,均P<0.05),抗Jo-1、抗MDA5抗体阳性者易出现肌无力(χ2=6.245、8.865,均P<0.05),抗MDA5抗体阳性者易出现向阳疹、Gottron疹、溃疡性皮疹(χ2=37.198、14.724、104.492,均P<0.05),抗ARS、抗Jo-1、抗EJ、抗MDA5抗体阳性者较易出现技工手(χ2=35.298、27.779、20.012、8.006,均P<0.05),抗ARS、抗Jo-1、抗MDA5、抗Mi-2抗体阳性者易出现发热(χ2=11.745、25.291、20.078、6.255,均P<0.05)。抗氨基酰tRNA合成酶抗体(ARS)抗体是PM/DM发生肺间质病变(ILD)的独立危险因素(OR=4.348,95%CI:1.653~11.436,P=0.003),抗TIF1-γ抗体是PM/DM合并肿瘤的独立危险因素(OR=5.483,95%CI:1.427~21.065,P=0.013)。所有PM/DM患者随访1~37个月,死亡8例,累计生存率84.2%,不同MSAs患者预后差异无统计学意义,多因素回归分析并未显示MSAs是影响PM/DM患者生存的独立危险因素。结论PM/DM患者血清中MSAs阳性率高,不同MSAs与不同临床特征相关,密切关注抗ARS抗体PM/DM患者的ILD,积极筛查肿瘤尤其是存在抗TIF1-γ抗体的PM/DM患者,MSAs并不直接影响PM/DM患者的短期�Objective To investigate the correlation of myositis-specific antibody(MSA)subtypes with clinical characteri-stics and prognosis of patients with polymyositis(PM)/dermatomyositis(DM).Methods The clinical data of 131 DM patients and 6 PM patients admitted in Ningbo First Municipal Hospital from January 2017 to January 2020 were collected.The correlation of MSAs subtypes with clinical data were analyzed.Factors influencing clinical features were analyzed with logistic regression.The survival of patients was analyzed with Kaplan-Meier curve,and the prognostic factors of PM/DM patients were determined with multivariate Cox regression analysis.Results Among 137 PM/DM patients there were 40 males and 97 females;and the overall positive rate of MSAs was 77.37%.Anti-Jo-1 antibody,anti-MDA5 antibody and anti-TIF1-γantibody were the most common MSAs,with positive rates of 19.71%,13.87%and 15.33%,respectively.The subtypes of MSAs were closely related to different clinical characteristics of PM/DM patients.Anti-TIF1-γand anti-NXP antibodies were likely to be associated with dysphagia(χ2=24.847,P<0.001;P=0.005);anti-ARS and anti-Jo-1 antibodies were more likely to be associated with myalgia(χ2=4.314,7.146,both P<0.05).Anti-Jo-1 and anti-MDA5 antibodies were commonly associated with myasthenia(χ2=6.245,8.865,both P<0.05);and anti-MDA5 antibodies were commonly associated with sun rash(χ2=37.198),Gottron rash(χ2=14.727)and ulcerative rash(χ2=104.492).Anti-ARS,anti-Jo-1,anti-EJ and anti-MDA5 antibodies were likely to be related to mechanic hand(χ2=35.298,27.779,20.012,8.006,all P<0.05),anti-ARS,anti-Jo-1,anti-MDA5,and anti-Mi-2 antibodies were likely to be related to fever(χ2=11.745,25.291,20.078,6.255,all P<0.05).Anti-ARS antibody was an independent risk factor for interstitial lung disease(ILD)in PM/DM(OR=4.348,95%CI:1.653-11.436,P=0.003).Anti-TIF1-γantibody was an independent risk factor for PM/DM with tumors(OR=5.483,95%CI:1.427-21.065,P=0.013).All PM/DM patients were followed up for 1~37 months,8 patients died,and

关 键 词：多肌炎 皮肌炎 肌炎特异性抗体 生存 

分 类 号：R593.26[医药卫生—内科学]