不同预后的抗MDA5抗体阳性IIMs患者肺部HRCT定量指标与临床研究

Quantitative Indexes and Clinical Studies of Lung HRCT in Patients with Anti-MDA5 Antibody-positive Iims with Different Prognoses and Clinical Studies

目的:比较分析不同预后的抗黑色素瘤分化相关基因5(MDA5)抗体阳性特发性炎性肌病(IIMs)患者的肺部HRCT定量指标与临床表现。方法:回顾性分析2017年2月至2022年11月首都医科大学附属北京世纪坛医院收治的19例MDA5抗体阳性IIMs患者的临床及影像学数据,将患者按预后不同分为预后良好组(14例)及预后不良(插管或死亡)组(5例),比较两组患者的临床及实验室指标、间质性肺病(ILD)类型及CT量化指标。结果:预后良好及不良组患者在性别、癌胚抗原、血氧饱和度、淋巴细胞百分比、单核细胞百分比、中性粒细胞百分比、淋巴细胞、中性粒细胞水平上差异具有统计学意义。预后不良组出现呼吸系统异常改变的比例更高。在ILD类型方面,预后不良组患者以急性间质性肺炎(AIP)样病变为主、预后良好组患者以非特异性间质性肺炎(NSIP)样病变为主,两组存在统计学差异。预后不良组半定量评分更高,全肺病灶体积更高且全肺病灶占比更高差异具有统计学意义。Spearman相关分析结果显示,血氧饱和度、单核细胞百分比与半定量评分、全肺病灶体积及全肺病灶占比呈负相关,癌胚抗原、中性粒细胞百分比、中性粒细胞与半定量评分、全肺病灶体积及全肺病灶占比呈正相关。结论:不同预后的MDA5抗体阳性IIMs患者的肺部HRCT定量指标、临床表现及实验室指标有差异,为临床诊疗提供了相应支持。

Objective:To compare the quantitative parameters of lung HRCT and clinical manifestations of anti-melanoma differentiation-associated gene 5(MDA5)antibody-positive idiopathic inflammatory myopathy(IIM)patients with different prognoses.Methods:The clinical and imaging data of 19 MDA5 antibody-positive IIM patients admitted to Beijing Shijitan Hospital Affiliated with Capital Medical University between February 2017 and November 2022 were retrospectively analyzed.According to the prognoses,the patients were divided into the good prognoses group(14 cases)and the poor prognoses(intubation or death)group(5 cases).The clinical and laboratory indexes,types of interstitial lung disease(ILD),and CT quantitative indexes were compared between the two groups.Results:There were significant differences in gender;carcinoembryonic antigen;blood oxygen saturation;and the percentages of lymphocytes,monocytes,neutrophils,lymphocytes,and neutrophils between the good versus the poor prognoses groups.The proportion of abnormal respiratory system changes was higher in the poor prognoses group.In terms of the type of ILD,acute interstitial pneumonia(AIP)-like lesions were the main type in the poor prognoses group,and nonspecific interstitial pneumonia(AIP)lesions were the main type in the good prognoses group.For NSIP-like lesions,there was a statistically significant difference between the two groups.The semi-quantitative score of the poor prognoses group was higher,and the volume of whole lung lesions as well as the proportion of whole lung lesions were also higher.Spearman correlation analysis showed that the blood oxygen saturation,monocyte percentage,semi-quantitative score,whole lung lesion volume,and proportion of whole lung lesion were negatively correlated,while carcinoembryonic antigen,neutrophil percentage,and neutrophils were positively correlated with the semi-quantitative score,whole lung lesion volume,and proportion of whole lung lesion.Conclusions:The lung HRCT quantitative indicators,clinical manifestations,and laboratory indicators are different in MDA5 antibody-positive IIM patients with different prognoses.Early evaluation of HRCT imaging manifestations,clinical manifestations,and laboratory indicators is of great significance in determining the prognosis of MDA5 antibody-positive IIM patients,which provides corresponding support for clinical diagnosis and treatment.