血清抗黑素瘤分化相关基因5抗体与抗组氨酰tRNA合成酶抗体检测在特发性炎性肌病中的比较

Comparison of serum anti-melanoma differentiation-associated gene-5 antibody and anti-histidyl tRNA synthetase antibody detections in idiopathic inflammatory myopathy

目的研究特发性炎性肌病(IIM)患者血清抗黑素瘤分化相关基因5(MDA5)抗体和抗组氨酰tRNA合成酶(Jo-1)抗体与临床特点关系。方法收集2017年1月~2019年12月我院收治的110例IIM患者的临床资料,其中26例患者抗MDA5抗体阳性,17例抗Jo-1抗体阳性,通过t检验、χ2检验及Kaplan-Meier法比较分析MDA5组与Jo-1组患者在临床表现、实验室指标、肺部CT改变及预后方面的差异。结果(1)IIM合并间质性肺炎患者抗MDA5抗体阳性率明显高于抗Jo-1抗体(44.8%vs.25.8%,P<0.05)。(2)与Jo-1组比较,MDA5组向阳征(69.2%vs.11.8%)及Gottron征(80.7%vs.17.6%)的发生率均明显增高(P<0.05);而肌无力发生率(15.3%vs.70.6%)、肌酸激酶(CK)水平[(110.0±26.7)U/L vs.(1720.0±774.4)U/L]均明显降低(P<0.05)。(3)两组患者间质性肺炎发生率(100.0%vs 88.2%)的比较,差异无统计学意义(P>0.05)。MDA5组患者急性/亚急性ILD的发生率明显高于Jo-1组(65.4%vs.13.3%,P<0.05),3个月生存率低于Jo-1组(P<0.05)。(4)男性患者、发病时间短、声嘶、恶性肿瘤及感染可能是MDA5组患者发生死亡的危险因素。结论两组患者在临床特点、HRCT表现以及预后存在差异,完善抗体检测有利于早期诊断、判断预后。

Objective To research the relationship between serum anti-melanoma differentiation-associated gene-5(MDA5)antibody and anti-histidyl tRNA synthetase(Jo-1)antibody and clinical features in patients with idiopathic inflammatory myopathy(IIM).Methods Clinical data of 110 patients with IIM admitted to our hospital from January 2017 to December 2019 were collected,and they were divided into the MDA5 group(n=26,patients were positive for anti-MDA5 antibody)and the Jo-1 group(n=17,patients were positive for anti-Jo-1 antibody).The differences in clinical manifestations,laboratory indexes,pulmonary CT changes and prognoses between the MDA5 group and the Jo-1 group were compared and analyzed by t-test,chi-square test and Kaplan-Meier method.Results(1)The positive rate of anti-MDA5 antibody in patients with inflammatory myopathy complicated with interstitial pneumonia was significantly higher than that of anti-Jo-1 antibody(44.8%vs.25.8%,P<0.05).(2)Compared with the Jo-1 group,the incidences of Yang syndrome(69.2%vs.11.8%)and Gottron syndrome(80.7%vs.17.6%)in the MDA5 group were significantly higher(P<0.05).The incidence of myasthenia gravis(15.3%vs.70.6%)and creatine kinase(CK)level([110.0±26.7]U/L vs.[1720.0±774.4]U/L)were significantly decreased(P<0.05).(3)There was no significant difference in the incidence of interstitial pneumonia(100.0%vs.88.2%)between the two groups(P>0.05).The acute/subacute ILD incidence in the MDA5 group was significantly higher than that in the Jo-1 group(65.4%vs.13.3%,P<0.05),and the three-month survival rate was lower than that in the Jo-1 group(P<0.05).(4)In male patients,short onset time,hoarseness,malignant tumor and infection may be the risk factors of mortality in the MDA5 group.Conclusion There are differences in clinical features,HRCT manifestations and prognoses between the two groups.It is beneficial to improve the antibody detection for early diagnosis and prognosis.