成人抗MDA5抗体阳性皮肌炎临床特征

Clinical Features of Adult Anti-MDA5 Antibody Positive Dermatomyositis

目的分析成人抗黑色素瘤分化相关基因5(MDA5)抗体阳性皮肌炎(DM)的临床特征,并与抗MDA5抗体阴性DM进行比较。方法收集2021年1月1日至12月31日郑州大学第一附属医院101例成人DM患者资料,根据抗MDA5抗体阳性与否分为抗MDA5抗体阳性(MDA5^(+))组和抗MDA5抗体阴性(MDA5^(-))组,对两组数据进行比较。收集抗MDA5抗体水平定量检测结果,分析其与其他实验室指标的相关性。结果MDA5^(+)组较MDA5^(-)组初诊住院时间长,1 a内住院次数多,发热和咳嗽咳痰症状出现频率较高,差异具有统计学意义(P<0.05)。与MDA5^(-)组相比,MDA5^(+)组红细胞沉降率、涎液化糖链抗原-6(KL-6)、铁蛋白水平升高,中性粒细胞、淋巴细胞、血小板、肌酸激酶、肌酸激酶同工酶水平降低,差异有统计学意义(P<0.05)。Spearman相关分析显示,抗MDA5抗体水平与D-二聚体、免疫球蛋白G、免疫球蛋白M水平呈正相关,与肌酸激酶同工酶水平呈负相关(P<0.05)。高分辨率CT显示,MDA5^(+)组肺间质性改变较MDA5^(-)组发生率高,差异有统计学意义(P<0.05)。结论MDA5^(+)DM较MDA5^(-)DM患者发热、咳嗽咳痰发生率高,肌肉受累较轻,易发生肺间质改变,病情较重,治疗较复杂。KL-6、铁蛋白、抗MDA5抗体水平可作为评估MDA5^(+)DM病情活动的指标。

Objective To analyze the clinical characteristics of anti-melanoma differentiation-associated gene 5(MDA5)antibody positive dermatomyositis(DM)in adults and compare them with anti-MDA5 antibody negative DM.Methods The data of 101 adult DM patients in the First Affiliated Hospital of Zhengzhou University from January 1 to December 31,2021 were collected and divided into anti-MDA5 antibody positive(MDA5^(+))group and anti-MDA5 antibody negative(MDA5^(-))group according to the anti-MDA5 antibody positive or not.The data of the two groups were compared.The quantitative detection results of anti-MDA5 antibody were collected,its correlation with other laboratory indexes was analyzed.Results Compared with the MDA5^(-)group,the MDA5^(+)group had longer hospital stay at initial diagnosis,more hospitalization times within one year,and higher frequency of fever,cough and sputum,the difference was statistically significant(P<0.05).Compared with the MDA5^(-)group,the levels of erythrocyte sedimentation rate,krebs von den lungen-6(KL-6)and ferritin were increased,and the levels of neutrophil,lymphocyte,platelet,creatine kinase and creatine kinase-MB were decreased in the MDA5^(+)group,with statistically significant differences(P<0.05).Spearman correlation analysis showed a positive correlation between anti-MDA5 antibody levels and D-dimer,immunoglobulin G,immunoglobulin M and a negative correlation with creatine kinase-MB(P<0.05).The high resolution CT displayed a higher number of interstitial lung changes in the MDA5^(+)group compared to the MDA5^(-)group,with a statistically significant difference(P<0.05).Conclusion Patients with MDA5^(+)DM have a higher incidence of fever,cough and sputum than patients with MDA5^(-)DM,have less muscle involvement,are more prone to interstitial lung changes,and are more severely ill and complicated to treat.KL-6,ferritin,and anti-MDA5 antibody levels can be used as indicators to assess disease activity in MDA5^(+)DM.