特发性肌炎相关肺间质病与特发性肺纤维化的临床比较  

Clinical Comparison Between Idiopathic Myositis-associated Interstitial Lung Disease and Idiopathic Pulmonary Fibrosis

作　　者：张明[1,2] 周淑红 张凯[4] 陈英 梁刘娜 张兆翠 潘亮[3] ZHANG Ming;ZHOU Shuhong;ZHANG Kai;CHEN Ying;LIANG Liuna;ZHANG Zhaocui;PAN Liang(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China;Department of Immunorheumatology,Zhangye Second People's Hospital,Zhangye 734000,Gansu,China;Department of Immunorheumatology,Gansu Provincial Hospital,Lanzhou 730000,Gansu,China;Department of Geriatrics,Shaanxi Second Provincial People's Hospital,Xi'an 710000,Shaanxi,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]张掖市第二人民医院风湿免疫科,甘肃张掖734000 [3]甘肃省人民医院免疫风湿科,甘肃兰州730000 [4]陕西省第二人民医院老年病科,陕西西安710000

出　　处：《医学信息》2025年第7期60-66,104,共8页Journal of Medical Information

基　　金：甘肃省自然科学基金(编号:22JR5RA68)。

摘　　要：目的比较特发性肌炎间质性肺病(PM/DM-ILD)与特发性间质肺纤维化(IPF)的临床特点。方法选取我院2018年10月-2021年10月住院治疗的43例诊断为PM/DM-ILD患者,按MDA5抗体检测结果分为MDA5-ILD组(n=13),非MDA5-ILD组(n=30),另外选取同期住院治疗的40例IPF患者作为IPF组。对三组患者一般情况、临床症状、实验室检查、肺功能、胸部HRCT进行回顾性分析。结果MDA5-ILD组病程短于非MDA5-ILD组及IPF组,丙氨酸转氨酶、GCO评分高于IPF组,高密度脂蛋白低于IPF组,丙氨酸转氨酶、GCO评分高于非MDA5-ILD组(P<0.016);非MDA5-ILD组ARS抗体阳性率高于MDA5-ILD组(P<0.016),肌酶升高阳性率IPF组(P<0.016),IPF组男性患者、发病年龄、DLCO%pre降低程度、F评分、C评分高于MDA5-ILD组和非MDA5-ILD组(P<0.016)。三组患者肺功能表现为限制性通气功能伴弥散功能障碍障碍为主,MDA5-ILD组HRCT分型以AIP和OP多见,非MDA5-ILD组HRCT分型以NSIP多见,IPF组HRCT分型以UIP多见。结论PM/DM-ILD与IPF组临床特点完全不同,MDA5-ILD与非MDA5-ILD临床特点存在差异,其中肌炎抗体、HRCT对ILD的诊治发挥重要作用。Objective To compare the clinical characteristics of idiopathic myositis interstitial lung disease(PM/DM-ILD)and idiopathic interstitial pulmonary fibrosis(IPF).Methods A total of 43 patients diagnosed with PM/DM-ILD who were hospitalized in our hospital from October 2018 to October 2021 were selected.According to the results of MDA5 antibody test,they were divided into MDA5-ILD group(n=13)and non-MDA5-ILD group(n=30).In addition,40 patients with IPF who were hospitalized during the same period were selected as IPF group.The general condition,clinical symptoms,laboratory examination,pulmonary function and chest HRCT of the three groups were retrospectively analyzed.Results The course of disease in MDA5-ILD group was shorter than that in non-MDA5-ILD group and IPF group,alanine aminotransferase and GCO scores were higher than those in IPF group,high density lipoprotein was lower than that in IPF group,alanine aminotransferase and GCO scores were higher than those in non-MDA5-ILD group(P<0.016).The positive rate of ARS antibody in non-MDA5-ILD group was higher than that in MDA5-ILD group(P<0.016).The positive rate of muscle enzyme elevation in IPF group was higher than that in MDA5-ILD group(P<0.016).Male patients,age of onset,DLCO%pre reduction,F score and C score in IPF group were higher than those in MDA5-ILD group and non-MDA5-ILD group(P<0.016).The lung function of the three groups showed restrictive ventilation function with diffusion dysfunction.The HRCT classification of the MDA5-ILD group was more common with AIP and OP.The HRCT classification of the non-MDA5-ILD group was more common with NSIP.Conclusion The clinical characteristics of PM/DM-ILD are completely different from those of IPF group.There are differences in clinical characteristics between MDA5-ILD and non-MDA5-ILD.Myositis antibody and HRCT play an important role in the diagnosis and treatment of ILD.

关 键 词：间质性肺疾病 特发性肌炎 特发性肺纤维化 MDA5抗体 

分 类 号：R563.13[医药卫生—呼吸系统]