皮肌炎合并间质性肺炎的危险因素及预后因素分析

Risk factors and prognostic factors analysis of dermatomyositis patients with interstitial lung disease

目的:探讨皮肌炎(DM)发生间质性肺炎(ILD)的危险因素及DM-ILD的预后因素。方法:选取2014年1月至2019年3月在郑州大学第一附属医院住院且符合Bohan/Peter分类标准的DM患者,收集临床资料并进行随访,由影像学专家根据肺部高分辨率CT对ILD进行形态学分型。将入选患者分为DM组和DM-ILD组,采用Logistic回归分析发生ILD的危险因素,Kaplan-Meier法比较2组的生存情况,并采用Cox回归分析预后影响因素。结果:共纳入249例DM患者,其中DM-ILD患者98例。ILD中最常见的类型是非特异型间质性肺炎,占74.49%,预后较好,而急性间质性肺炎(AIP)预后最差。Logistic回归分析提示抗Ro52抗体阳性、技工手、关节炎是发生ILD的危险因素[OR(95%CI)分别为5.167(2.737~9.754),4.733(1.849~12.113),2.266(1.189~4.319)]。生存分析提示DM-ILD患者1、3、5 a生存率分别为81.0%、72.0%、68.3%;呼吸困难、AIP、肺部感染是影响DM-ILD患者生存的危险因素[HR(95%CI)分别为21.416(7.836~58.528),8.220(1.899~35.575),4.018(1.388~11.626)]。结论:抗Ro52抗体阳性,合并技工手、关节炎的DM患者发生ILD的风险高;DM-ILD患者生存率低,呼吸困难、AIP、肺部感染者预后较差。

Aim:To investigate the risk factors of interstitial lung disease(ILD)in dermatomyositis(DM)patients and the prognostic factors.Methods:The patients with DM hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2014 to March 2019 and met the Bohan/Peter criteria were selected.The clinical data were collected and the patients were followed-up.The pulmonary HRCT was morphologically classified by expert radiologists.The patients were allocated into DM-ILD group and DM group.Logistic regression was used to analyze the risk factors of ILD.Kaplan-Meier method was used to compare the survival of the two groups,and Cox regression was used to analyze the prognostic factors of DM-ILD.Results:A total of 249 patients with DM(98 patients with DM-ILD)were enrolled.The most common type of ILD was non-specific interstitial pneumonia,accounting for 74.49%,with better prognosis,and the prognosis of acute interstitial pneumonia(AIP)was worst.Logistic regression analysis showed that positive anti-Ro52 antibody,mechanic′s hand,and arthritis were risk factors for ILD[OR(95%CI)were 5.167(2.737-9.754),4.733(1.849-12.113),2.266(1.189-4.319),respectively].Survival analysis showed that the 1-,3-and 5-year survival rates of DM-ILD patients were 81.0%,72.0%and 68.3%,respectively.Dyspena,AIP,and pulmonary infection were risk factors for survival[HR(95%CI)were 21.416(7.836-58.528),8.220(1.899-35.575),4.018(1.388-11.626),respectively].Conclusion:The patients with positive anti-Ro52 antibody,mechanic′s hand,or arthritis more likely develop ILD.The survival rate of DM-ILD patients is low;dyspnea,AIP,and pulmonary infection are prognostic risk factors for patients with DM-ILD.