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华西医学  2011 

炎性肌病患者肺部病变特点分析

, PP. 646-650

Keywords: 多发性肌炎,皮肌炎,无肌病性皮肌炎,并发症,肺疾病

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Abstract:

【】 目的 探讨新诊断的多发性肌炎(PM)、皮肌炎(DM)和无肌病性皮肌炎(ADM)肺部病变发生率、临床特点及相关因素。 方法 回顾性分析2008年1月―2010年7月新确诊的206例PM、DM、ADM临床表现、肺部影像学、肺功能、超声心动图和实验室指标。 结果 206例患者中合并肺部病变156例,以肺间质病变(ILD)最多见,占患者总数的51.46%。在性别、病程、是否吸烟方面合并ILD与无ILD患者相比差异无统计学意义,合并ILD患者年龄大于无ILD组。合并ILD患者呼吸困难、发热、雷诺现象、关节炎或关节痛概率增加。合并ILD组白蛋白低于无ILD组,血沉和免疫球蛋白IgM高于无ILD组。急性ILD组中女性患者及出现雷诺现象的概率高于慢性组。206例患者中死亡13例,其中周围型肺癌1例,特发性血小板减少并颅内出血1例,严重肺部感染11例;死亡患者中10例伴肺间质纤维化。合并急性ILD患者死亡率较慢性组高2倍。 结论 PM、DM、ADM患者肺部病变发生率高,以ILD多见,发热、年龄大、白蛋白降低、血沉升高、雷诺现象及关节炎或关节痛都是合并ILD的相关因素。合并急性ILD患者预后差,死亡者常合并肺部感染。【Abstract】 Objective Toexploretheprevalence,clinicalfeatures,andpredictivefactorsofpulmonaryinvolvementinnewlydiagnosedpolymyositis(PM),dermatomyositis(DM)andamyopathicdermatomyositis(ADM),inordertocarryoutearlydiagnosisandtreatment,andimprovetheprognosis. Methods Theclinicalmanifestations,chestimaging,pulmonaryfunctiontest,ultrasoniccardiographyandlaboratoryresultsof206inpatientswithPM,DMandADMinWestChinaHospitalofSichuanUniversityfromJanuary2008toJuly2010werereviewedretrospectively. Results Onehundredandfifty-sixoutof206patientsdevelopedPM/DM/ADMassociatedlungdiseases,including106cases(51.46%)ofinterstitiallungdisease(ILD).Therewasnosignificantdifferenceingender,diseaseduration,andsmokingornotbetweentheILDandnon-ILDgroup,butpatientsintheILDgroupweresignificantlyolderthannon-ILDgroup.TheresultsalsoshowedthatpatientswithILDweremuchmorelikelytohavesymptomsofbreathingdifficulties,fever,Raynaudphenomenonandarthritis/arthralgia.ThepatientswithILDhadlowerlevelofalbuminbuthigherlevelsofESRandIgM;InthegroupofacuteILD,femalepatientsandtheratioofRaynaudphenomenonwerehigherthanthoseinthechronicitygroup.Ofthe206patients,13patientsdied,including1deathofperipherallungcancer,1ofessentialthrombocytopeniaandintracranialhemorrhages,and11ofseverelunginfection,and10inthesepatientsdevelopedILD.MortalityinpatientswithacuteILDwas2timeshigherthanthechronicitygroup. Conclusion TheprevalenceoflungdiseasesishighinpatientswithPM,DMandADM.ILDisthemainpulmonaryinvolvement,andfever,olderageatonset,hypoalbuminemia,highervaluesofbloodsedimentation,RaynaudphenomenonandarthritisorarthralgiawerethepredictivefactorsfordevelopingILD.PatientswithacuteILDhavepoorprognosis.Deathcasesoftenhavepulmonaryinfections.

References

[1]   Kang EH, Lee EB, Shin KC, et al. Interstitial lung disease in patients with polymyositis, dermatomyositis and amyopathic dermatomyositis[J]. Rheumatology (Oxford), 2005, 44(10): 1282-1286.
[2]   Mukae H, Ishimoto H, Sakamoto N, et al. Clinical differences between interstitial lung disease associated with clinically amyopathic dermatomyositis and classic dermatomyositis[J]. Chest, 2009, 136(5): 1341-1347.
[3]   Sontheimer RD, Miyagawa S. Potentially fatal interstitial lung disease can occur in clinically amyopathic dermatomyositis[J]. J Am Acad Dermatol, 2003, 48(5): 797-798.
[4]   Lee CS, Chen TL, Tzen CY, et al. Idiopathic inflammatory myopathy with diffuse alveolar damage[J]. Clin Rheumatol, 2002, 21(5): 391-396.
[5]   Ye S, Chen XX, Lu XY, et al. Adult clinically amyopathic dermatomyositis with rapid progressive interstitial lung disease: a retrospective cohort study[J]. Clin Rheumatol, 2007, 26(10): 1647-1654.
[6]   Ji SY, Zeng FQ, Guo Q, et al. Predictive factors and unfavourable prognostic factors of interstitial lung disease in patients with polymyositis or dermatomyositis: a retrospective study[J]. Chin Med J (Engl), 2010, 123(5): 517-522.
[7]   Hengstman GJ, van Engelen BG, van Venrooij WJ. Myositis specific autoantibodies: changing insights in pathophysiology and clinical associations[J]. Curr Opin Rheumatol, 2004, 16(6): 692-699.
[8]   Mimori T, Imura Y, Nakashima R, et al. Autoantibodies in idiopathic inflammatory myopathy: an update on clinical and pathophysiological significance[J]. Curr Opin Rheumatol, 2007, 19(6): 523-529.
[9]   Dankó K, Ponyi A, Constantin T, et al. Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases[J]. Medicine (Baltimore), 2004, 83(1): 35-42.
[10]   Marie I, Hatron PY, Hachulla E, et al. Pulmonary involvement in polymyositis and in dermatomyositis[J]. J Rheumatol, 1998, 25(7): 1336-1343.
[11]   Fathi M, Dastmalchi M, Rasmussen E, et al. Interstitial lung disease, a common manifestation of newly diagnosed polymyositis and dermatomyositis[J]. Ann Rheum Dis, 2004, 63(3): 297-301.
[12]   Marie I, Hachulla E, Chérin P, et al. Interstitial lung disease in polymyositis and dermatomyositis[J]. Arthritis Rheum, 2002, 47(6): 614-622.
[13]   Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts)[J]. N Engl J Med, 1975, 292(7): 344-347.
[14]   Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts)[J]. N Engl J Med, 1975, 292(8): 403-407.
[15]   Euwer RL, Sontheimer RD. Amyopathic dermatomyositis: a review[J]. J Invest Dermatol, 1993, 100(1): 124S-127S.
[16]   Won Huh J, Soon Kim D, Keun Lee C, et al. Two distinct clinical types of interstitial lung disease associated with polymyositis-dermatomyositis[J]. Respir Med, 2007, 101(8): 1761-1769.
[17]   Schwarz MI. The lung in polymyositis[J]. Clin Chest Med, 1998, 19(4): 701-712.
[18]   Callen JP. Dermatomyositis[J]. Lancet, 2000, 355(9197): 53-57.
[19]   Marie I, Hachulla E, Hatron PY, et al. Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis[J]. J Rheumatol, 2001, 28(10): 2230-2237.
[20]   Marie I, Hatron PY, Levesque H, et al. Influence of age on characteristics of polymyositis and dermatomyositis in adults[J]. Medicine (Baltimore), 1999, 78(3): 139-147.
[21]   Taggart AJ, Finch MB, Courtney PA, et al. Anti Jo-1 myositis. ’Mechanic’s hands’ and interstitial lung disease[J]. Ulster Med J, 2002, 71(1): 68-71.
[22]   Richards TJ, Eggebeen A, Gibson K, et al. Characterization and peripheral blood biomarker assessment of anti-Jo-1 antibody-positive interstitial lung disease[J]. Arthritis Rheum, 2009, 60(7): 2183-2192.
[23]   Schnabel A, Reuter M, Biederer J, et al. Interstitial lung disease in polymyositis and dermatomyositis: clinical course and response to treatment[J]. Semin Arthritis Rheum, 2003, 32(5): 273-284.
[24]   Chen IJ, Jan Wu YJ, Lin CW, et al. Interstitial lung disease in polymyositis and dermatomyositis[J]. Clin Rheumatol, 2009, 28(6): 639-646.

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