皮肌炎伴发肺间质病变的相关因素分析

Analysis of factors related to the development of interstitial lung disease in 206 patients with dermatomyositis

目的探讨皮肌炎（DM）伴发肺间质病变（ILD）的临床特点及其相关因素。方法回顾分析复旦大学附属华山医院皮肤科近6年来收治的206例DM患者临床资料，采用x2检验、t检验等分析DM伴发ILD的影响因素。结果I）M患者ILD的发生率为49．03％。上眼睑红斑、Gottron征、关节痛、咳嗽等临床表现均为DM伴发ILD的相关因素（P值均〈0．05），其中咳嗽、关节痛与ILD的发生率呈正相关，而Gottron征与ILl）的发生率呈负相关。DM伴发ILD患者乳酸脱氢酶、羟丁酸脱氢酶、抗Jo-1抗体等实验室指标异常发生率显著高于DM不伴发ILD的患者（P值均〈0．05）。DM伴发ILD患者肺功能较DM不伴发ILD患者显著下降（P〈0．05），其肺部CT表现主要为肺尖删i底部的条索影（57．4％）、高密度斑片影（31．7％）、网格影（16．8％）、磨砂玻璃影（13．8％）。结论DM患者关节痛、咳嗽症状的发生率与ILD呈正相关，而Gottron征的发生率与ILD的伴发率呈负相关。DM伴发ILD患者肺部CT特征性表现为肺尖，月市底部条索影、斑片影、磨玻璃影和网格影。

Objective To assess the clinical features and associated factors of interstitial lung disease （ILD） in patients with dermatomyositis （DM）. Methods Clinical data were retrospectively analyzed on 206 patients with DM collected at the Department of Dermatology, Huashan Hospital, Fudan University in the past 6 years. Chi-square test and t test were performed for statistical analysis. Results The prevalence of ILD was 49.03% in the 206 patients with DM. Heliotrope rash on the upper eyelids, Gottron＇s sign （papules）, arthralgia, and cough were correlated with the incidence of ILD in DM patients Call P 〈 0.05）, and of these factors, the prevalence of artharalgia and cough were positively correlated with the incidence of ILD, while the presence of Gottron＇s papules was negatively correlated. The patients with DM and ILD showed a higher prevalence of abnormal serum levels of lactate dehydrogenase （LDH）, hydroxybutyrate dehydrogenase （HBDH） and anti-Jo-1 antibodies, as well as with a poorer pulmonary function, compared with those suffering from DM only （all P 〈 0.05）. Characteristic imaging findings on computed tomography （CT） scan in patients with DM and ILD included linear opacity （57.4%）, high-density patchy opacity （31.7%）, reticular opacity （16.8%） and even ground glass-like opacity （13.8%）, usually at the bottom or apex of the lungs. Conclusions In patients with DM, the prevalence of artharalgia and cough is positively correlated, whereas the presence of Gottron＇ s papules is negatively correlated, with the incidence of ILD. Characteristic imaging findings on CT scan in patients with DM and ILD are linear opacity, high-density patchy opacity, reticular opacity and ground glass-like opacity at the bottom and apex of lungs.