抗黑色素瘤分化相关基因5抗体阳性皮肌炎的胸部高分辨率CT分析与临床特征  

The high-resolution chest CT findings and clinical features of dermatomyositis with anti-melanoma differentiation-associated gene 5 antibody

作　　者：陈望[1] 史晓飞[2] 陈殿森[1] 史展[1] 宋乐乐[1] Chen Wang;Shi Xiaofei;Chen Diansen;Shi Zhan;Song Lele(Department of Radiology,First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Rheumatology and Immunology,First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院影像中心,洛阳471003 [2]河南科技大学第一附属医院风湿免疫科,洛阳471003

出　　处：《中华风湿病学杂志》2022年第1期22-26,共5页Chinese Journal of Rheumatology

基　　金：河南省医学科技攻关计划联合共建项目(2018020298)。

摘　　要：目的探讨抗黑色素瘤分化相关基因5(MDA5)抗体阳性DM合并肺间质病变的高分辨率CT(HRCT)表现、实验室特点及临床特征,并分析其与临床病程的相关性。方法收集确诊抗MDA5抗体阳性相关DM患者27例,根据病程分为2组:急性/亚急性进展组(15例)和慢性进展组(12例)。回顾性分析患者肺部HRCT图像,记录肺间质性病变的部位、类型和出现的频次,同时收集患者性别、年龄、临床表现、病程等临床资料及抗MDA5抗体、抗Ro52抗体、抗组氨酰tRNA合成酶抗体(抗Jo-1抗体)、ANA和肌酸激酶(CK)、ESR等实验室指标,对2组患者指标进行组间比较,分析其与临床病程的相关性。组间比较采用χ^(2)检验进行统计分析。结果①共分析27例患者肺部HRCT图像,合并间质性改变100%(27/27),单侧局限型分布占比48%(13/27),双侧局限分布型占比30%(8/27),弥漫分布型占比22%(6/27)。②肺间质改变HRCT表现中,磨玻璃影59%(16/27)、胸膜下弧线63%(17/27)及小叶间隔增厚56%(15/27)多发,蜂窝征发生率最低0(0/27)。③急性/亚急性进展组与慢性进展组比较,突出临床表现为胸闷[80%(12/15)与8%(1/12),χ^(2)=13.715,P<0.05]、呼吸困难[47%(7/15)与0(0/12),χ^(2)=7.560,P<0.05]。急性/亚急性组突出HRCT肺间质性表现为磨玻璃影高于慢性组[87%(13/15)与25%(3/12),χ^(2)=10.501,P<0.05];慢性病程组突出肺间质HRCT表现为小叶间隔增厚高于急性/亚急性组[83%(10/12)与33%(5/15),χ^(2)=6.750,P<0.05]。④抗MDA5抗体(+++)指标2组间差异有统计学意义[80%(12/15)与25.0%(3/12),χ^(2)=8.168,P<0.05],抗Ro52(+)、ANA(+)、抗Jo-1抗体(+)、CK升高、ESR升高等指标2组间差异无统计学意义(P>0.05)。结论抗MDA5抗体阳性DM患者大多合并肺间质性病变,肺HRCT表现多样,本病确诊需结合临床表现、实验室及病理检查。Objective To investigate the high resolution computed tomography(HRCT)findings,laboratory test results and clinical manifestations of anti-melanoma differentiation-associated gene 5(MDA5)antibody positive dermatomyositis complicated with lung interstitial lesions,and to analyze the correlation between the HRCT findings and clinical course of disease.Methods Twenty-seven patients with anti-MDA5 antibody positive associated dermatomyositis(DM)were included and divided into two groups:acute/subacute group(n=15)and chronic group(n=12).HRCT images of lung were analyzed.Clinical data including gender,age,clinical manifestations and course of disease,anti-Ro52 antibody,creatine kinase(CK),antinuclear antibody(ANA),anti-Jo-1 antibody and erythrocyte sedimentation rate(ESR)were also collected.χ^(2)test was adopted for statistical analysis.Results①Interstitial changes were 100%(27/27).The proportion of unilateral localized distribution was the most[48%(13/27)],followed by bilateral localized distribution[30%(8/27)],and bilateral diffuse distribution[22%(6/27)].②Among the HRCT findings of lung interstitial changes,ground glass shadow was the most common presentations[59%(16/27)],followed by subpleural curve sign[63%(17/27)]and interlobular septal thickening[56%(15/27)],while honeycomb sign[0(0/27)]had the lowest rate of presentation.③Compared with the chronic progressive group,the acute/subacute progressive group presented as chest tightness(80%vs 8%,χ^(2)=13.715,P<0.05)and dyspnea(47%vs 0,χ^(2)=7.560,P<0.05).Acute/subacute HRCT showed ground glass opacity(87%vs 25%,χ^(2)=10.501,P<0.05).The prominent HRCT showed interlobular septal thickening in the chronic course group(83%vs 33%,χ^(2)=6.750,P<0.05).④The anti-MDA5 antibody(+++)index was significantly different(88%vs 25%,χ^(2)=8.168,P<0.05).There was no significant difference in anti-Ro52 antibody(+),ANA(+),anti-Jo-1 antibody(+),CK elevation and ESR elevation between the two groups(P>0.05).Conclusion Most dermatomyositis patients with positive anti-MDA5 antibod

关 键 词：皮肌炎 肺疾病 间质性 黑色素瘤分化相关基因5 CT 

分 类 号：R593.26[医药卫生—内科学]