细胞角蛋白19片段在抗黑色素瘤分化相关基因5抗体阳性皮肌炎患者中的临床意义  

Clinical significance of cytokeratin 19 fragment in anti-melanoma differentiation-associated protein-5 antibody positive patients

作　　者：关文娟[1] 刘丽君[1] 张盼盼 王聪[2] 张欣[1] 张丽娟 韩立帅[1] 张寅丽 贺玉杰[1] 刘升云[1] Guan Wenjuan;Liu Lijun;Zhang Panpan;Wang Cong;Zhang Xin;Zhang Lijuan;Han Lishuai;Zhang Yinli;He Yujie;Liu Shengyun(Department of Rheumatology and Immunology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院风湿免疫科,郑州450052 [2]郑州大学第一附属医院妇科,郑州450052

出　　处：《中华风湿病学杂志》2025年第3期189-196,共8页Chinese Journal of Rheumatology

基　　金：国家自然科学基金(82371819);河南省医学科技攻关计划省部共建项目(SBGJ202003025)。

摘　　要：目的探讨细胞角蛋白19片段(CYFRA21-1)升高在抗黑色素瘤分化相关基因5(MDA5)抗体阳性皮肌炎(MDA5-DM)患者中的临床意义。方法收集2018年6月至2021年10月期间在郑州大学第一附属医院首诊为抗MDA5抗体阳性皮肌炎(MDA5-DM)的142例住院患者资料,根据CYFRA21-1是否>4 ng/ml,将患者分为CYFRA21-1低水平组(CYFRA21-1≤4 ng/ml)和高水平组(CYFRA21-1>4 ng/ml)。收集患者临床资料,比较2组的临床表现、实验室检查、影像学检查、治疗及预后。统计学分析采用独立样本t检验、Mann-Whitney U检验,χ^(2)检验或Fisher精确检验法;危险因素分析采用logistic回归,生存分析采用Kaplan-Meier法。结果CYFRA21-1高水平组的发病年龄[(56±9)岁和(50±10)岁,t=-3.50,P=0.001]高于CYFRA21-1低水平组。CYFRA21-1高水平组发热更常见[63.3%(38/60)和40.2%(33/82),χ^(2)=7.39,P=0.007],合并关节炎[41.7%(25/60)和69.5%(57/82),χ^(2)=11.01,P=0.001]更少见。肌痛、肌无力、皮疹、雷诺现象和皮肤溃疡等与低水平组相比差异无统计学意义。CYFRA21-1高水平组白细胞计数[5.2(4.1,6.9)×10^(9)/L和4.3(3.2,6.2)×10^(9)/L,Z=-2.57,P=0.010]、中性粒细胞计数[4.0(2.9,5.5)×10^(9)/L和2.9(2.1,4.5)×10^(9)/L,Z=-3.25,P=0.001]、中性粒/淋巴细胞比值[5.75(3.50,9.20)和3.55(2.64,5.41),Z=-3.77,P<0.001]较CYFRA21-1低水平组显著升高。同时乳酸脱氢酶(LDH)[384(302,519)U/L和318(260,405)U/L,Z=-2.98,P=0.003]、铁蛋白[1204(677,2039)ng/ml和570(229,846)ng/ml,Z=-4.78,P<0.001]、涎液化糖链抗原(KL-6)[995(658,1491)U/ml和750(563,1197)U/ml,Z=-2.49,P=0.013]、ESR[36(22,61)mm/1 h和28(15,46)mm/1 h,Z=-2.18,P=0.029]、CRP[9.2(4.7,31.5)mg/L和3.1(1.1,11.6)mg/L,Z=-3.53,P<0.001]在CYFRA21-1高水平组显著升高,而血清白蛋白[(32±5)g/L和(35±5)g/L,t=3.92,P<0.001]则显著降低。2组间血清抗MDA5抗体的滴度差异无统计学意义。CYFRA21-1高水平组抗Ro52抗体阳性率[44(74.6%)和44(53.7%),χ^(2)=6.40,P=0.011]较CYFRA21-1低水平组升高�ObjectiveTo investigate the clinical significance of elevated cytokeratin 19 fragment(CYFRA21-1)in patients with dermatomyositis associated with positive anti-melanoma differentiation-associated gene 5(MDA5)antibody.Methods142 consecutive cases with newly onset anti-MDA5(+)(MADEDM)-DM admitted to the first affiliated hospital of Zhengzhou University from June 2018 to October 2021 were enrolled.They were divided into two groups,the low serum CYFRA21-1 group(CYFRA21-1≤4 ng/ml)and the high serum CYFRA21-1 group(CYFRA21-1>4 ng/ml).The clinical manifestations,laboratory tests results,imaging examinations treatment and outcome were collected for statistical analysis.Enumeration data were expressed as the number of cases and percentage(%).Normally distributed parameters were tested by t-test.Parameters with skewed distribution were tested by Mann-Whitney Wilcoxon analysis.Categorical variables were compared by the Chi-square test or Fisher′s exact test.Risk factor analysis was performed using Logistic regression.Cumulative survivals were described by Kaplan-Meier curves.ResultsThe age of onset in the high CYFRA21-1 group[(56±9)years vs.(50±10)years,t=-3.50,P=0.001]was higher than that in the low CYFRA21-1 group.Fever[63.3%(38/60)vs.40.2%(33/82),χ^(2)=7.39,P=0.007]was more common in the high CYFRA21-1 group,and arthritis[41.7%(25/60)vs.69.5%(57/82),χ^(2)=11.01,P=0.001]was less common.Myalgia,myasthenia,rashes,Raynaud′s phenomenon and skin ulcers had no significant difference between the two groups.The WBC count[5.2(4.1,6.9)×10^(9)/L vs.4.3(3.2,6.2)×10^(9)/L,Z=-2.57,P=0.010],neutrophil count[4.0(2.9,5.5)×10^(9)/L vs.2.9(2.1,4.5)×10^(9)/L,Z=-3.25,P=0.001]and neutrophil/lymphocyte ratio[5.75(3.50,9.20)vs.3.55(2.64,5.41),Z=-3.77,P<0.001]in high CYFRA21-1 group were significantly higher than those in low CYFRA21-1 group.At the same time,LDH[384(302,519)U/L vs.318(260,405)U/L,Z=-2.98,P=0.003],ferritin[1204(677,2039)ng/ml vs.570(229,846)ng/ml,Z=-4.78,P<0.001],KL-6[995(658,1491)U/ml vs.750(563,1197)U/ml,Z=-2.49,P=0

关 键 词：皮肌炎 肺疾病 间质性 角蛋白19 抗黑色素瘤分化相关基因5抗体 

分 类 号：R593.26[医药卫生—内科学]