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合并间质性肺病的皮肌炎患者发生呼吸衰竭的危险因素分析
Risk Factors of Respiratory Failure in the Dermatomyositis Patients with Interstitial Lung Disease
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摘要: 目的探讨合并间质性肺病（ILD）的皮肌炎（DM）患者（DM-ILD）发生呼吸衰竭（RF）的相关临床特点及危险因素分析。方法DM-ILD患者以是否发生RF分为RF组（40例）和非RF组（82例），回顾性分析两组患者临床、实验室检查及影像学资料等临床特点，并采用非条件logistic回归分析影响DM-ILD患者发生RF的危险因素。结果发生RF的患者中，男女比例为1∶3，DM的发病年龄中位数为49.5（42.3～58.6）岁，其在半年、1年及2年病程内发生RF的百分比分别为67.5%、85.0%、95.0%。单因素分析发现，更晚的发病年龄、临床无肌病皮肌炎 (CADM)、纵隔气肿、更高的天冬氨酸转氨酶(AST) 及乳酸脱氢酶水平，更低的血清白蛋白水平，升高的中性粒细胞／淋巴细胞比值及血小板／淋巴细胞比值，抗Jo-1抗体阴性，胸部高分辨CT中的磨玻璃影与RF的发生有关（POR=1.791,P=0.025)、 AST更高 (OR=1.937,P=0.048)、 CADM (OR=3.881,P=0.007) 及磨玻璃影 (OR=4.187,P=0.014) 是DM-ILD患者发生RF的独立危险因素。结论RF常发生在DM发病后的2年内。发病年龄较晚、AST增高、存在磨玻璃影或被诊断为CADM的患者发生RF的风险更大。抗Jo-1抗体阳性的患者发生RF的可能性较低。
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关键词:
- 皮肌炎 肺疾病，间质性 呼吸功能不全
Abstract: Objective To reveal the clinical features of respiratory failure (RF) in dermatomyositis (DM) patients with interstitial lung disease (ILD), and to explore risk factors of RF in these patients. Methods The medical data of 122 DM patients with ILD were retrospectively reviewed: 40 developed RF (RF group), 82 did not develope RF (Non RF group). Clinical, laboratory and radiological variables were compared between RF patients and Non RF patients. Multivariate Logistic regression was used to analyze risk factors of RF. Results In RF patients, the female-male ratio was 3∶1, the median age at DM onset was 49.5 （42.3-58.6) years-old. There were 67.5%, 85.0% and 95.0% patients developed RF within 6 months, 1 year and 2 years after the onset of DM. The factors significantly associated with RF included DM onset age, clinically amyopathic dermatomyositis (CADM), pneumomediastinum (PNM), aspartate aminotransferase(AST), lactate dehydrogenase (LDH), albumin, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, anti-Jo-1 antibody presence and ground-glass opacities sign (POR)=1.791, P=0.025〕, higher AST level (OR=1.937, P=0.048), CADM diagnosis (OR=3.881, P=0.007) and ground-glass opacities sign (OR=4.187, P=0.014) were independent risk factors of RF in DM patients with ILD. ConclusionsRF occurs more often within 2 years of DM onset. The DM patients with older DM onset age, elevated AST level, CADM diagnosis or ground-glass opacities sign took higher risks for RF development. -
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期刊类型引用(7)
1. 钱丰，汤红端. 间质性肺病患者并发呼吸衰竭的影响因素研究. 现代医学与健康研究电子杂志. 2024(09): 118-121 . 
百度学术
2. 颜卫峰，陈喆，许文兵，郭军. 合并间质性肺病皮肌炎患者呼吸衰竭危险因素分析. 海南医学. 2020(05): 600-603 . 百度学术
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4. 杨帆，沈俊逸，俞烨晨，王娜娜，蔡辉. 补脾益气药联合泼尼松对自身免疫性炎性肌病大鼠血清激酶的影响研究. 世界中西医结合杂志. 2019(11): 1535-1538 . 百度学术
5. 崔贝贝，谢其冰，尹耕. 自身免疫性疾病的共病现象——一个需要多学科关注的领域. 四川大学学报(医学版). 2018(02): 169-173+158 . 百度学术
6. 邹慧敏，郝延磊. 特发性炎性肌病的相关特异性抗体的研究进展. 国际神经病学神经外科学杂志. 2018(05): 519-523 . 百度学术
7. 王洵，杨漪菲，王子溪，王燕，顾馨，任天丽，陶诗沁，吕尚瑞，高一宁，蒋志寒，赵弘卿. 老年多发性肌炎/皮肌炎患者临床特点分析. 老年医学与保健. 2018(06): 701-704 . 百度学术
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