肌炎特异性抗体与特发性炎性肌病患者症状特征及短期预后的相关性分析

Correlation Analysis of Myositis Specific Antibody with Symptom Characteristics and Short-term Prognosis in Patients with Idiopathic Inflammatory Myopathy

目的研究肌炎特异性抗体(MSAs)与特发性炎性肌病患者症状特征及短期预后的相关性。方法收集2018年6月-2020年6月经我院确诊的48例特发性炎性肌病患者的临床资料进行回顾性分析,依据MSAs的检出结果分为MSAs阳性组(n=32)与MSAs阴性组(n=16),比较两组症状特征及短期预后情况,分析MSAs亚型与症状特征的相关性。结果MSAs阳性组间质性肺病(ILD)及吞咽困难的发生率高于MSAs阴性组(P<0.05);两组V颈征、向阳疹、Gottron征、披肩征、技工手、雷诺现象、关节炎、肌痛、肌无力、皮下钙化发生率比较,差异无统计学意义(P>0.05);经单因素及Logistic回归分析显示,抗转录中介因子γ(TIF1-γ)抗体阳性、抗氨基酰tRNA合成酶(ARS)抗体阳性、抗小泛素样修饰物活化酶(SAE)抗体阳性是吞咽困难发生的独立危险因素(P<0.05,OR>1),而抗黑色素瘤分化相关基因5(MDA5)抗体阳性是吞咽困难的保护因素(P<0.05,OR<1);抗MDA5阳性是ILD的独立危险因素(P<0.05,OR>1),抗Mi-2抗体阳性、抗TIF1-γ抗体阳性为ILD的保护因素(P<0.05,OR<1);1年的随访观察中,MSAs阳性组与MSAs阴性组的预后生存情况比较,差异无统计学意义(P>0.05)。结论MSAs与特发性炎性肌病中ILD及吞咽困难的发生存在相关性,但MSAs对患者短期预后并无直接影响。

Objective To study the correlation between myositis-specific antibodies(MSAs)and the symptoms and short-term prognosis of patients with idiopathic inflammatory myopathy.Methods The clinical data of 48 patients with idiopathic inflammatory myopathy diagnosed in our hospital from June 2018 to June 2020 were retrospectively analyzed.According to the detection results of MSAs,they were divided into MSAs positive group(n=32)and MSAs negative group(n=16).The symptom characteristics and short-term prognosis of the two groups were compared,and the correlation between MSAs subtypes and symptom characteristics was analyzed.Results The incidence of interstitial lung disease(ILD)and dysphagia in MSAs positive group was higher than that in MSAs negative group(P<0.05);there was no significant difference in the incidence of V neck sign,Yang rash,Gottron sign,shawl sign,technician,Reynolds phenomenon,arthritis,muscle pain,muscle weakness and subcutaneous calcification between the two groups(P>0.05).Single factor and Logistic regression analysis showed that anti-transcription mediator factorγ(TIF1-γ)antibody positive,anti-aminoacyl tRNA synthetase(ARS)antibody positive and anti-small ubiquitin-like modifier activator(SAE)antibody positive were independent risk factors for dysphagia(P<0.05,OR>1),while anti-melanoma differentiation-related gene 5(MDA5)antibody positive was a protective factor for dysphagia(P<0.05,OR<1);anti-MDA5 positive was an independent risk factor for ILD(P<0.05,OR>1),anti-Mi-2 antibody positive and anti-TIF1-γantibody positive were protective factors for ILD(P<0.05,OR<1).During one-year follow-up,there was no significant difference in the prognosis and survival between MSAs positive group and MSAs negative group(P>0.05).Conclusion MSAs are associated with ILD and dysphagia in idiopathic inflammatory myopathy,but MSAs have no direct effect on the short-term prognosis of patients.