The predictive value of NLR and SII in anti⁃MDA5 antibody⁃positive dermatomyositis with rapidly progressive interstitial lung disease  

NLR和SII对抗MDA5抗体阳性皮肌炎伴快速进展型肺炎的预后价值

作　　者：CAI Qingqing YOU Hanxiao WANG Lei LÜChengyin SHI Yumeng QIU Yulu WU Lingyun WANG Fang ZHANG Miaojia TAN Wenfeng 蔡清清;尤含笑;王磊;吕成银;石雨濛;邱雨露;吴凌云;王芳;张缪佳;谈文峰(南京医科大学第一附属医院风湿免疫科,江苏南京210029;南京中医药大学附属南京市中医院老年科,江苏南京210022;南京医科大学第一附属医院心内科,江苏南京210029)

机构地区：[1]Department of Rheumatology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 [2]Department of Gerontology,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210022 [3]Division of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China

出　　处：《南京医科大学学报(自然科学版)》2025年第2期196-207,共12页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82171794,82071827,82271844);国家自然科学青年基金(82302041);国家重点研发计划课题(2021YFC2501305);江苏省科教能力提升项目(JSDW202203);宿迁市科技计划(KY202201,KY202302);江苏省医院临床能力提升项目(JSPH⁃MB⁃2023⁃13,JSPH⁃MA⁃2002⁃6)。

摘　　要：Objective:To evaluate the predictive value of the neutrophil⁃to⁃lymphocyte ratio(NLR)and the systemic immune⁃inflammation index(SII)in predicting patients with anti⁃melanoma differentiation⁃associated gene 5⁃positive(anti⁃MDA5+)dermatomyositis(DM)develop into the rapidly progressive interstitial lung disease(RPILD).Methods:We retrospectively analyzed the clinical and laboratory data of 124 anti⁃MDA5+DM patients from the First Affiliated Hospital of Nanjing Medical University between March 2019 and September 2023.We identified independent risk factors associated with the development and mortality of RPILD with the Cox regression analysis,and determined the optimal cut⁃off values for predicting adverse outcomes with the receiver operating characteristic(ROC)curve analysis.Results:Among the 124 patients,36 patients(29.03%)developed RPILD,and 39 patients(31.45%)died during the follow⁃up period.The results of multivariate Cox regression analysis showed that the elevated NLR was an independent risk factor for RPILD development,while the elevated SII expression was independently associated with the increased mortality of RPILD.Based on the ROC curve analysis,NLR>6.12 was a predictor for RPILD,and SII>875.79 was associated with increased mortality risk of RPILD.Conclusion:Both NLR and SII are accessible,cost⁃effective,and reliable prognostic indicators for the prognosis of patients with anti⁃MDA5^(+)DM,providing a valuable guidance for clinical management and risk stratification of the disease.目的:评估中性粒细胞与淋巴细胞比值(neutrophil⁃to⁃lymphocyte ratio,NLR)和全身免疫炎症指数(systemic immune⁃inflammation index,SII)在预测抗黑色素瘤分化相关基因5阳性皮肌炎(anti⁃melanoma differentiation⁃associated gene 5⁃positive dermatomyositis,抗MDA5+DM)患者发展为快速进展型间质性肺病(rapidly progressive interstitial lung disease,RPILD)的预测价值。方法:回顾性分析2019年3月—2023年9月南京医科大学第一附属医院124例抗MDA5+DM患者的临床和实验室资料,采用Cox回归分析确定与RPILD发展和病死率相关的独立危险因素。进行受试者工作特征(receiver operating characteristic,ROC)曲线分析,以确定预测不良结局的最佳临界值。结果:124例患者中,36例(29.03%)发生RPILD,39例(31.45%)在随访期间死亡。多因素Cox回归分析发现NLR升高是RPILD的独立危险因素,而SII升高与病死率独立相关。根据ROC曲线确定,NLR>6.12是RPILD的预测因子,SII>875.79时死亡风险增加。结论:NLR和SII是抗MDA5^(+)DM患者简单、经济、可靠的预后指标,为临床管理和风险分层提供了有价值的指导。

关 键 词：anti⁃melanoma differentiation⁃associated gene 5⁃positive dermatomyositis neutrophil⁃to⁃lymphocyte ratio rapidly pro⁃gressive interstitial lung disease systemic immune⁃inflammation index 

分 类 号：R593.26[医药卫生—内科学] R563.1[医药卫生—临床医学]