抗信号识别粒子抗体阳性间质性肺炎的临床特点分析及与抗Jo-1抗体阳性间质性肺炎的比较

Analysis of clinical characteristics of anti-SRP antibody positive interstitial pneumonia and comparison with anti-Jo-1 antibody positive interstitial pneumonia

目的探讨抗信号识别粒子抗体阳性的间质性肺炎(anti-signal recognition particle antibody positive interstitial pneumonia,SRP-IP)患者的临床特点,并与抗Jo-1抗体阳性的间质性肺炎(anti-Jo-1 antibody positive interstitial pneumonia,Jo1-IP)患者相比较。方法回顾性分析2017年5月—2021年5月南京大学医学院附属鼓楼医院呼吸与危重症医学科收治的SRP-IP住院患者的临床资料,包括临床表现、实验室检查、肺功能结果、影像学类型等,并与同期收住的Jo1-IP患者相比较。结果SRP-IP患者年龄大于Jo1-IP患者(P=0.044),在临床表现和肺功能方面,两组患者各项没有显著统计学差异。SRP-IP患者中合并存在抗EJ抗体(P<0.001)、核周型抗中性粒细胞抗体(P=0.028)阳性比例显著高于Jo1-IP患者,合并抗Ro-52抗体阳性比例显著低于Jo1-IP患者(P=0.009)。SRP-IP患者的红细胞沉降率快于Jo1-IP患者(P=0.026),血清IgM水平(P=0.039)和外周血NK细胞计数(P=0.013)明显低于Jo1-IP患者。SRP-IP患者胸部CT表现类型以机化性肺炎型最为常见,寻常型间质性肺炎型的比例高于Jo-IP患者(P=0.032)。高滴度(++~+++)SRP抗体的间质性肺炎患者的肌酸激酶(P=0.010)、肌酸激酶同工酶(P=0.025)、谷丙转氨酶(P=0.045)水平均高于低滴度(+)SRP抗体的间质性肺炎患者。SRP-IP和Jo1-IP患者的治疗方案以糖皮质激素联合/不联合免疫抑制剂为主,两组在治疗方案的选择上无显著差异。Jo1-IP患者疗效评估为好转的比例明显高于SRP-IP患者(P=0.005),而SRP-IP患者疗效评估为稳定的比例明显高于Jo1-IP患者(P=0.035)。SRP-IP患者3个月内病死率显著高于Jo1-IP患者(P=0.028)。结论SRP-IP与Jo1-IP患者相比,患者年龄更大,红细胞沉降率更快,更易合并存在其他自身抗体,血清IgM水平和外周血NK细胞计数更低,寻常型间质性肺炎型影像学表现更多见,短期预后更差。

Objective To investigate the clinical characteristics of interstitial pneumonia patients with positive anti-signal recognition particle antibody(SRP-IP),and compare those with interstitial pneumonia patients with positive anti-Jo-1 antibody(Jo1-IP).Methods Clinical data of SRP-IP patients admitted to Department of Respiratory and Critical Care Medicine of Drum Tower Hospital affiliated to Nanjing University Medical School from May 2017 to May2021,including clinical manifestations,laboratory examinations,pulmonary function tests and radiographic types,were retrospectively analyzed.The results were compared with those of Jo1-IP patients admitted during the same period.Results The SRP-IP patients were older than Jo1-IP patients(P=0.044).There were no significant differences in clinical manifestations or pulmonary function tests results between the two groups.The proportion of SRP-IP patients combined with positive anti-EJ antibody(P<0.001)or perinuclear anti-neutrophil cytoplasmic antibody(P=0.028)was significantly higher than that of Jo1-IP patients,while the proportion of SRP-IP patients combined positive anti-Ro-52 antibody was significantly lower than that of Jo1-IP patients(P=0.009).The erythrocyte sedimentation rate(ESR)of SRP-IP patients was faster than that of Jo1-IP patients(P=0.026).The serum IgM level(P=0.039)and peripheral NK cell counts(P=0.013)of SRP-IP patients were significantly lower than those of Jo1-IP patients.The most common chest CT findings in SRP-IP patients were organizing pneumonia and the proportion of usual interstitial pneumonia in SRP-IP patients was higher than that of Jo1-IP patients(P=0.032).The levels of creatine kinase(P=0.010),creatine kinase myocardial brand(P=0.025)and alanine aminotransferase(P=0.045)in interstitial pneumonia patients with high titer(++~+++)SRP antibody were higher than those in interstitial pneumonia patients with low titer(+)SRP antibody.SRP-IP and Jo1-IP patients were mainly treated with glucocorticoids combined with or without immunosuppressants,and there was no significant difference in the choice of treatment between the two groups.The proportion of patients with Jo1-IP evaluated as improved was significantly higher than that of patients with SRP-IP(p=0.005),while the proportion of patients with SRPIP evaluated as stable was significantly higher than that of patients with Jo1-IP(P=0.035).The mortality of SRP-IP patients within 3 months was significantly higher than that of Jo1-IP patients(P=0.028).Conclusion Compared with Jo1-IP patients,SRP-IP patients are older,have faster ESR,are more likely to be combined with other autoantibodies,have lower serum IgM level and peripheral blood NK cell count,have more UIP imaging manifestations,and have a worse short-term prognosis.