临床无肌病性皮肌炎的临床特征及外周血淋巴细胞亚群的特点研究

Study on the clinical features and peripheral blood lymphocyte subsets of clinically amyopathic dermatomyositis

目的 分析临床无肌病性皮肌炎(CADM)的临床特征及外周血淋巴细胞亚群的分布。方法 回顾性研究2020年1月至2023年1月于山东第一医科大学第一附属医院住院的CADM患者49例、经典皮肌炎(DM)患者60例的临床资料,比较两组患者临床资料、淋巴细胞亚群计数及百分比,采用多因素logistic回归分析影响CADM发生的危险因素。CADM组按是否合并技工手分为CADM合并技工手组(17例)和CADM不合并技工手组(32例);按抗体类型分为抗黑色素瘤分化相关基因5(MDA5)抗体阳性CADM组(26例)和抗氨基酰t RNA合成酶(ARS)抗体阳性CADM组(18例);比较亚组患者淋巴细胞亚群计数及百分比。结果 CADM组快速进展性肺间质纤维化(RP-ILD)、Gottron疹和(或)征、技工手、抗MDA5抗体和癌胚抗原高于DM组,“V”字领、披肩征、CK和CK-MB低于DM组,差异均有统计学意义(P<0.05)。CADM患者CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3-CD16/56^(+)、CD3^(+)CD16/56^(+)和CD4^(+)CD25^(+)细胞计数及CD3-CD16/56^(+)和CD4^(+)CD25^(+)细胞百分比低于DM组,CD3-CD19^(+)细胞百分比高于DM患者,差异有统计学意义(P<0.05)。CD3-CD19^(+)细胞百分比(OR 1.208,95%CI 1.009~1.447,P=0.040)是CADM的独立危险因素。CADM合并技工手组CD3^(+)CD8^(+)细胞百分比低于不合并技工手组,抗MDA5抗体阳性CADM组CD3-CD16/56^(+)百分比、CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3-CD16/56^(+)、CD3^(+)CD16/56^(+)和CD4^(+)CD25^(+)细胞计数低于抗ARS抗体阳性CADM,差异有统计学意义(P<0.05)。结论 与DM相比,CADM患者T细胞减少、B细胞增多,淋巴细胞亚群明显异常,淋巴细胞亚群可能参与CADM的发生。

Objective To analyze the clinical features and distribution of lymphocyte subsets in peripheral blood of clinically amyopathic dermatomyositis(CADM).Methods A retrospective analysis was conducted on the clinical data of 49 patients with CADM and 60 patients with classic dermatomyositis(DM)admitted to the First Affiliated Hospital of Shandong First Medical University from January 2020 to January 2023.Compare the clinical clata lymphocyte subpopulation count and percentage among two groups of patients;multivariate logistic regression analysis was used to analyze independent risk factors for CADM.The CADM patients were divided into CADM group with mechanic's hands(17 cases)and CADM group without mechanic's hands(32 cases);and they were divided into group of CADM with anti-melanoma differentiationassociated gene 5 antibody positive group(26 cases)and group of CADM with anti-aminoacyl-tRNA synthetase antibody positive group(18 cases);the number and percentage of lymphocyte subsets in subgroups were compared.Results The rapidly progressive ILD(RP-ILD),Gottron sign,mechanic's hands,anti MDA5 antibody,and CEA in the CADM group were higher than those in the DM group.While the V shawl neck sign,the cape sign,CK and CK-MB in the CADM group were lower than those in the DM group,with significant differences(P<0.05).The cell counts of CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+),CD3-CD16/56^(+),CD3^(+)CD16/56^(+)and CD4^(+)CD25^(+)and the percentage of CD3-CD16/56^(+)and CD4^(+)CD25^(+)cells in CADM patients were significantly lower than those in DM patients,while the percentage of CD3-CD19^(+)cells in CADM patients was significantly higher than that in DM patients,with significant differences(P<0.05).CD3-CD19^(+)cell percentage(OR 1.208,95%CI 1.009-1.447,P=0.040)is the independent risk factor for CADM.The percentage of CD3^(+)CD8^(+)cells in CADM patients with mechanic's hands was significantly lower than in patients without mechanic's hands.The percentage of CD3-CD16/56^(+)and the cell counts of CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3-CD16/56^(+)、CD3^(+)CD16/56^(+),and CD4^(+)CD25^(+)in CADM with positive anti-MDA5 antibodies were significantly lower than CADM with positive anti-ARS antibodies(P<0.05).Conclusion Compared with DM,CADM has a decrease in T cells,an increase in B cells,and a significant abnormality in lymphocyte subsets,which may be involved in the pathogenesis of CADM.