特发性炎性肌病间质性肺炎患者并发肺部感染的临床特征

Clinical features of patients with idiopathic inflammatory myopathy and interstitial lung disease when complicated with pulmonary infection

目的:研究特发性炎性肌病(IIM)间质性肺炎(ILD)并发肺部感染时的临床特征。方法:回顾性分析我院2014年1月至2017年12月连续收治的IIM-ILD患者的临床资料,根据临床表现、实验室检查、影像学检查等将其按是否合并肺部感染分为合并感染组和未合并感染组。比较2组患者临床资料及外周血淋巴细胞亚群水平,采用χ^2检验、Mann-Whitney U检验、多因素Logistic回归分析处理数据,并绘制受试者工作特征曲线,评估淋巴细胞亚群的诊断价值。结果:共纳入153例患者,其中合并感染组51例,未合并感染组102例。合并感染组的患者的肌痛、皮疹、咳嗽咳痰、畏寒发热、ALT、LDH、ESR及CRP均高于未合并感染组,而外周血淋巴细胞计数明显减低(Z=-3.283,P<0.05)。多因素logistic回归分析表明肌痛、咳嗽咳痰、LDH>350 U/L、淋巴细胞计数<0.9×10^9/L是IIM-ILD患者合并肺部感染的独立危险因素(OR值分别为4.31、3.81、2.70和2.44,P均<0.05)。外周血淋巴细胞亚群中,合并感染组患者NK细胞及CD3^+、CD3^+CD4^+、CD3^+CD8^+T细胞数均明显减低(分别为Z=-2.28,P<0.05;Z=-3.094,P<0.05;Z=-2.918,P<0.05;Z=-2.308,P<0.05)。受试者工作特征曲线分析显示CD3+T细胞联合CRP可以提高IIM-ILD合并肺部感染诊断的敏感度(AUC=0.729)。结论:IM-ILD患者合并感染时更容易出现肌痛、咳嗽咳痰以及LDH升高。外周血T细胞数量的减少预示IIM-ILD患者并发肺部感染的风险增大。

Objective Toanalyze the clinical features of patients with idiopathic inflammatory myopathy(IIM)and interstitial lung disease(ILD)when complicated with pulmonary infection.Methods Clinical data ofconsecutive IIM patients admitted to our hospital from January 2014 to December 2017 were collected.Patients were divided into two groups:pure IIM-ILD and IIM-ILD with pulmonary infection,and the difference in clinical manifestations and lab test results was compared.The ROC curve was used to evaluate the predictive diagnostic value of T lymphocytes.The data was analyzed by the Chi-square test,Mann-Whitney U test and multiple logistic regression analysis.Results Totally 153 patients were included,in which 51 cases were complicated with pulmonary infection.The incidence of myalgia,rash,cough/expectoration and fever and the levels of aspartate aminotransferase,lactate dehydrogenase(LDH),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were increased in the infection group,while the number of lymphocytes was significantly decreased(P<0.05).Multivariate logistic regression analysis showed that myalgia,cough/expectoration,serum LDH level>350 U/L and peripheral blood lymphocyte count<0.9×10^9/L were independent risk factors for pulmonary infection in IIM-ILD patients(ORvalues 4.31,3.81,2.70 and 2.44,respectively,P<0.05).Meanwhile,the number of natural killer cells as well as CD3+,CD3+CD4+,CD3+CD8+T cells in the infection group was significantly lower than that in the pure IIM-ILD group(Z values-2.28,-3.094,-2.918,and-2.308,respectively,P<0.05).ROC curve showed that CD3+T cells combined with CRP improved the diagnostic sensitivity of pulmonary infection in IIM-ILD.Conclusion IIM-ILD patients are more likely to have myalgia,cough/expectoration as well as increased LDH level when complicated with infection.The decrease in peripheral T lymphocyte numbers may indicate an increased risk of pulmonary infection in these patients.