作者：康悦，刘红，张国瑞，余亚丽

单位：

450052河南省郑州市，郑州大学第一附属医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

关键词：

皮肌炎；肺疾病，间质性；抗黑色素瘤分化相关基因5抗体；抗Ro-52抗体

Keywords：

Dermatomyositis; Lung diseases, interstitial; Anti-melanoma differentiation associated gene 5 antibody;Anti-Ro-52 antibody

CLC：

R 593.26　R 563.13

DOI：

10.12114/j.issn.1008-5971.2022.00.219

Funds：

国家重点研发计划精准医学研究专项（2016YFC0901100）

摘要：

目的　分析抗Ro-52抗体对抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎（DM）患者发生快速进展型间质性肺疾病（RP-ILD）及其预后的影响。方法　回顾性选取2019年10月至2021年12月于郑州大学第一附属医院确诊为抗MDA5抗体阳性的DM患者142例为研究对象。根据RP-ILD发生情况，将患者分为RP-ILD组（发生RP-ILD，53例）和非RP-ILD组（未发生RP-ILD，89例）。根据抗MDA5抗体滴度，将患者分为弱阳性组（抗MDA5抗体滴度为32~89 U/ml，22例）、中阳性组（抗MDA5抗体滴度为90~149 U/ml，32例）和强阳性组（抗MDA5抗体滴度≥150 U/ml，88例）。收集患者临床资料，采用多因素Logistic回归分析探讨抗MDA5抗体阳性DM患者发生RPILD的影响因素；采用Kaplan-Meier法绘制生存曲线，生存率的比较采用Log-rank检验。结果　RP-ILD组乳酸脱氢酶（LDH）、抗Ro-52抗体阳性率高于非RP-ILD组（P ＜0.05）。多因素Logistic回归分析结果显示，抗Ro-52抗体阳性是抗MDA5抗体阳性DM患者发生RP-ILD的危险因素〔OR =3.062，95%CI （1.396，6.715），P ＜0.05〕。弱阳性组、中阳性组、强阳性组抗Ro-52抗体阳性率比较，差异无统计学意义（P ＞0.05）。弱阳性组中，抗Ro-52抗体阳性患者RPILD发生率与抗Ro-52抗体阴性患者比较，差异无统计学意义（P ＞0.05）；中阳性组、强阳性组中，抗Ro-52阳性患者RP-ILD发生率高于抗Ro-52抗体阴性患者（P ＜0.05）。弱阳性组、中阳性组、强阳性组生存率比较，差异有统计学意义（P ＜0.05）。抗MDA5抗体阳性DM患者、中阳性组中，抗Ro-52抗体阳性患者生存率低于抗Ro-52抗体阴性患者（P ＜0.05）。弱阳性组、强阳性组中，抗Ro-52抗体阳性患者与抗Ro-52抗体阴性患者生存率比较，差异无统计学意义（P ＞0.05）。结论　在抗MDA5抗体阳性DM患者中，抗Ro-52抗体阳性发生率较高，且其是患者发生RP-ILD的独立危险因素，与抗MDA5抗体阳性DM患者尤其是抗MDA5抗体滴度为90~149 U/ml的DM患者预后不良有关。

Abstract：

Objective　To analyze the effects of anti-Ro-52 antibody on rapidly progressive interstitial lungdisease (RP-ILD) and prognosis in patients with anti-melanoma differentiation associated gene 5 (MDA5) antibody-positivedermatomyositis (DM) . Methods　A total of 142 DM patients diagnosed with anti-MDA5 antibody positive in the First AffiliatedHospital of Zhengzhou University from October 2019 to December 2021 were retrospectively selected as the research objects.According to the occurrence of RP-ILD, the patients were divided into RP-ILD group (with RP-ILD, n=53) and non-RP-ILDgroup (without RP-ILD, n=89) . According to the anti-MDA5 antibody titers, the patients were divided into weak positive group(anti-MDA5 antibody titer was 32-89 U/ml, n=22) , moderate positive group (anti-MDA5 antibody titer was 90-149 U/ml, n=32)and strong positive group (anti-MDA5 antibody titer was ≥ 150 U/ml, n=88) . The clinical data of the patients were collected, andmultivariate Logistic regression analysis was conducted to analyze the risk factors for RP-ILD in anti-MDA5 antibody-positiveDM patients. The Kaplan-Meier method was used to draw survival curves, and Log-rank test was carried out to compare thesurvival rates. Results　Lactate dehydrogenase (LDH) and the positive rate of anti-Ro-52 antibody in RP-ILD group were higherthan those in non-RP-ILD group (P < 0.05) . Multivariate Logistic regression analysis showed that anti-Ro-52 antibody was arisk factor for RP-ILD in anti-MDA5 antibody-positive DM patients [OR =3.062, 95%CI (1.396, 6.715) , P < 0.05] . There was nosignificant difference in the positive rate of anti-Ro-52 antibody among weak positive group, moderate positive group and strongpositive group (P > 0.05) . In the weak positive group, there was no significant difference in the incidence of RP-ILD betweenanti-Ro-52 antibody-positive patients and anti-Ro-52 antibody-negative patients (P > 0.05) . In the moderate positive groupand the strong positive group, the incidence of RP-ILD in the anti-Ro-52 positive group was higher than that in the anti-Ro-52antibody negative group (P < 0.05) . There was significant difference in survival rate among weak positive group, moderate positivegroup and strong positive group (P < 0.05) . In the anti-MDA5 antibody-positive DM patients and the moderate positive group,the survival rate of anti-Ro-52 antibody-positive patients was lower than that of anti-Ro-52 antibody-negative patients (P <0.05) . In the weak positive group and the strong positive group, there was no significant difference in the survival rate between theanti-Ro-52 antibody positive patients and the anti-Ro-52 antibody negative patients (P > 0.05) . Conclusion　In anti-MDA5antibody-positive DM patients, the incidence of anti-Ro-52 antibody is higher, and it is an independent risk factor for RP-ILDin patients, and is associated with poor prognosis in anti-MDA5 antibody-positive DM patients, especially those with anti-MDA5antibody titers of 90-149 U/ml.

ReferenceList：