多发性肌炎/皮肌炎合并肺间质性病变病理临床特征探讨

Investigation of pathological clinical characteristics of polymyositis/dermatomyositis complicated with interstitial lung disea

目的分析多发性肌炎(PM)/皮肌炎(DM)合并肺间质性病变(ILD)患者临床病理特征,为临床诊疗工作提供指导。方法 60例确诊的PM/DM、ILD患者,PM/DM伴ILD患者为A组(20例),PM/DM未合并ILD患者为B组(40例)。分析两组临床症状与实验室病理检查结果。结果 A组患者吞咽困难、关节痛、抗Jo-1抗体阳性例数均比B组多(P<0.05)。A组患者乳酸脱氢酶(LDH)、血沉(ESR)均比B组低(P<0.05)。A组经糖皮质激素治疗后肌酸激酶(CK)水平低于B组(P<0.05)。结论 PM/DM患者并发ILD几率较高,且无典型症状,常规肺部检查十分必要。不同病变情况患者CT检查可发现不同类型阴影。要警惕影像学检查胸膜增厚、原因不明的女性ILD患者PM/DM的发生。临床上要密切关注血沉快、关节痛、抗Jo-1抗体呈阳性、血清LDH上升等ILD典型预示性指标。

Objective To analyze clinical pathological characteristics of polymyositis(PM)/dermatomyositis(DM) complicated with interstitial lung disease(ILD), and to provide guidance for clinical diagnosis and treatment work. Methods In 60 diagnosed PM/DM and ILD patients, those with PM/DM complicated with ILD were in group A(20 cases), and those with PM/DM and without ILD were in group B(40 cases). Clinical symptoms and pathological examination outcomes were analyzed in the two groups. Results Group A had more cases with dysphagia, arthralgia, and positive anti-Jo-1 antibody than group B(P<0.05). Group A had lower lactate dehydrogenase(LDH) and erythrocyte sedimentation rate(ESR) than group B(P<0.05). After glucocorticoid treatment, group A had lower creatine kinase(CK) level than group B(P<0.05). Conclusion PM/DM patients have high incidence of ILD, without typical symptoms, therefore it is necessary to have routine lung examination. CT examination in patients with difference disease status will show various shades. Imaging examination of pleural thickening and unknown occurrence of PM/DM in female ILD patients are essential for warning. Close observation should be made on typical ILD predictive indications, such as quick erythrocyte sedimentation rate, arthralgia, positive anti-Jo-1 antibody, and increasing serum LDH.