抗黑素瘤分化相关基因5抗体阳性重症皮肌炎患者抗转录中介因子1γ抗体状态与临床特点相关性分析  

Analysis of clinical characteristics of patients with severe dermatomyositis with positive anti-melanoma differentiation-associated gene 5 antibody and anti-transcriptional intermediary factor 1 gamma antibody

作　　者：王方明 刘敏黎 汤茜 宋冬明 孙建 WANG Fang-ming;LIU Min-li;TANG Qian;SONG Dong-ming;SUN Jian(Department of Rheumatology and Immunology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China)

机构地区：[1]江南大学附属医院风湿免疫科,江苏无锡214000

出　　处：《创伤与急危重病医学》2023年第1期9-13,19,共6页Trauma and Critical Care Medicine

基　　金：无锡市卫生健康委员会项目(Q20198);江南大学附属医院临床研究与转化医学研究项目(LCYJ202213)。

摘　　要：目的 探讨抗黑素瘤分化相关基因5(MDA5)抗体阳性重症皮肌炎患者抗转录中介因子1γ(TIF1γ)抗体状态与临床特点的相关性。方法 选取自2018年1月至2022年1月收治的重症皮肌炎患者62例为研究对象。检测62例重症皮肌炎患者的抗MDA5抗体和抗TIF1γ抗体状态。分析抗MDA5抗体阳性重症皮肌炎患者抗TIF1γ抗体状态与临床特点的关系。Log-rank检验分析抗MDA5抗体水平与抗TIF1γ抗体状态对预后的影响。以抗MDA5抗体浓度的中位数为阈值,划分为弱抗MDA5抗体水平和强抗MDA5抗体水平,分析不同抗MDA5抗体水平的重症皮肌炎患者中抗TIF1γ抗体状态与临床症状的关系。结果 抗TIF1γ抗体阳性重症皮肌炎患者的铁蛋白水平、人肌酸激酶水平、人乳酸脱氢酶水平、C反应蛋白水平、红细胞沉降率均高于抗TIF1γ抗体阴性重症皮肌炎患者,差异有统计学意义(P<0.05)。在弱抗MDA5抗体水平的重症皮肌炎患者中,抗TIF1γ抗体阳性与阴性患者比较,差异无统计学意义(P>0.05);但在强抗MDA5抗体水平的重症皮肌炎患者中,抗TIF1γ抗体阳性患者显著多于抗TIF1γ抗体阴性患者,差异有统计学意义(P<0.05)。Log-rank检验结果显示,存活率从低到高依次为强抗MDA5抗体阳性+抗TIF1γ抗体阳性[60.0%(15/25)]、强抗MDA5抗体阳性+抗TIF1γ抗体阴性[66.7%(4/6)]、弱抗MDA5抗体阳性+抗TIF1γ抗体阳性[87.5%(14/16)]、弱抗MDA5抗体阳性+抗TIF1γ抗体阴性[93.3%(14/15)],差异有统计学意义(P<0.05)。重症皮肌炎患者临床表现中,抗MDA5抗体阳性伴抗TIF1γ抗体阳性患者皮肤溃疡、声嘶、快速进展性间质性肺病(RP-ILD)所占比例明显高于抗MDA5抗体阳性伴抗TIF1γ抗体阴性患者,差异有统计学意义(P<0.05)。结论 抗TIF1γ抗体在抗MDA5抗体阳性的重症皮肌炎患者中的阳性率较高,且抗MDA5抗体阳性伴抗TIF1γ抗体阳性与皮肤溃疡、声嘶、RP-ILD相关。结合抗MDA5抗体水平和抗TIF1Objective To investigate the correlation between anti-transcriptional intermediary factor 1 gamma(TIF1γ) antibody status and clinical features in patients with anti-melanoma differentiation-associated gene 5(MDA5) antibody-positive severe dermatomyositis.Methods Sixty-two patients with severe dermatomyositis who were admitted from January 2018 to January 2022were selected for the study.The anti-MDA5 antibody and anti-TIF1γ antibody status of 62 patients with severe dermatomyositis were tested.The relationship between anti-MDA5 antibody positive patients with severe dermatomyositis and the analysis of clinical characteristics was analyzed.Log-rank test was used to analyze the effect of anti-MDA5 antibody level and anti-TIF1γ antibody status on prognosis.The median of anti-MDA5 antibody concentration was used as the threshold to classify the weak antiMDA5 antibody level and the strong anti-MDA5 antibody level,and the relationship between anti-TIF1γ antibody status and clinical symptoms in patients with severe dermatomyositis with different anti-MDA5 antibody levels was analyzed.Results Ferritin levels,creatine kinase levels,lactatedehydrogenase levels,C-reactiveprotein levels, anderythrocyte sedimentation rate were higher in patients with anti-TIF1γ antibody-positive severe dermatomyositis than in patients with anti-TIF1γ antibody-negative severe dermatomyositis,and the differences were statistically significant(P <0.05).In patients with severe dermatomyositis with weak antiMDA5 antibody levels,there was no statistically significant difference in the comparison of anti-TIF1γ antibody status(P >0.05).However,in patients with severe dermatomyositis with strong anti-MDA5 antibody levels,there were significantly more anti-TIF1γantibody-positive patients than anti-TIF1γ antibody-negative patients,and the difference was statistically significant(P <0.05).Log-rank test showed that the survival rate from low to high was strong anti-MDA5 antibody positive+anti-TIF1γ antibody positive[60.0%(15/25)],strong anti-MDA5

关 键 词：抗黑素瘤分化相关基因5抗体 抗转录中介因子1γ抗体 重症 皮肌炎 

分 类 号：R593[医药卫生—内科学]