|
|
妊娠合并MDA-5阳性皮肌炎1例及文献回顾
|
Abstract:
目的：探讨妊娠合并MDA-5阳性皮肌炎的临床特点及母婴结局，为临床医生提供诊疗思路，以减少不良妊娠结局的发生。方法：本文报道1例河北省人民医院收治妊娠合并MDA-5阳性DM的患者，分析其病例特征、诊疗经过、辅助检查及诊断，并进行相关文献复习。结论：妊娠合并MDA-5阳性皮肌炎患者疾病进展迅速，可伴随快速进展型肺间质病变，母婴结局较差，目前相关报道较少，缺乏对本病的安全可靠的治疗经验。随着医学技术的不断提高，对该病的治疗应以减少母婴不良结局为主，规范化、个体化治疗。
Objective: To explore the clinical characteristics and maternal and infant outcomes of pregnancy complicated with MDA-5-positive dermatomyositis, and provide clinical doctors with diagnosis and treatment ideas to reduce the occurrence of adverse pregnancy outcomes. Method: This article reports a case of pregnancy complicated with MDA-5-positive DM admitted to Hebei Provincial People’s Hospital. The case characteristics, diagnosis and treatment process, auxiliary examinations and diagnosis were analyzed, and relevant literature review was conducted. Conclusion: Pregnant women with MDA-5-positive dermatomyositis have rapid disease progression and may be accompanied by rapidly progressing pulmonary interstitial lesions, with poor maternal and infant outcomes. Currently, there are few relevant reports and a lack of safe and reliable treatment experience for this disease. With the continuous improvement of medical technology, the treatment of this disease should focus on reducing adverse outcomes for both mother and baby, and provide standardized and personalized treatment.
| [1] | 中华医学会风湿病学分会. 多发性肌炎和皮肌炎诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(12): 828-831. |
| [2] | Akiyama, C., Shirai, T., Sato, H., Fujii, H., Ishii, T. and Harigae, H. (2022) Association of Various Myositis-Specific Autoantibodies with Dermatomyositis and Polymyositis Triggered by Pregnancy. Rheumatology International, 42, 1271-1280. https://doi.org/10.1007/s00296-021-04851-1 |
| [3] | Nombel, A., Fabien, N. and Coutant, F. (2021) Dermatomyositis with Anti-MDA5 Antibodies: Bioclinical Features, Pathogenesis and Emerging Therapies. Frontiers in Immunology, 12, Article 773352. https://doi.org/10.3389/fimmu.2021.773352 |
| [4] | Oya, K., Inoue, S., Saito, A., Nakamura, Y., Ishitsuka, Y., Fujisawa, Y., et al. (2020) Pregnancy Triggers the Onset of Anti-Transcriptional Intermediary Factor 1γ Antibody-Positive Dermatomyositis: A Case Series. Rheumatology, 59, 1450-1451. https://doi.org/10.1093/rheumatology/kez527 |
| [5] | Lu, X., Peng, Q. and Wang, G. (2023) Anti-MDA5 Antibody-Positive Dermatomyositis: Pathogenesis and Clinical Progress. Nature Reviews Rheumatology, 20, 48-62. https://doi.org/10.1038/s41584-023-01054-9 |
| [6] | Ito, Y., Yamamoto, Y., Suzuki, Y., Noda, K. and Nakajima, A. (2022) Clinical and Serological Features and Pregnancy Outcomes in Women with Polymyositis/dermatomyositis: A Case-Based Review. Internal Medicine, 61, 143-149. https://doi.org/10.2169/internalmedicine.7924-21 |
| [7] | Abe, S., Tsuboi, H., Toko, H., Yagishita, M., Ohyama, A., Kitada, A., et al. (2024) Postpartum Onset Anti-MDA5 Antibody-Positive Clinically Amyopathic Dermatomyositis; Case-Based Review of Perinatal Onset Anti-MDA5 Antibody-Positive Dermatomyositis. Rheumatology International, 44, 2197-2203. https://doi.org/10.1007/s00296-024-05703-4 |
| [8] | Lian, X., Zou, J., Guo, Q., Chen, S., Lu, L., Wang, R., et al. (2020) Mortality Risk Prediction in Amyopathic Dermatomyositis Associated with Interstitial Lung Disease. Chest, 158, 1535-1545. https://doi.org/10.1016/j.chest.2020.04.057 |
| [9] | Bohan, A. and Peter, J.B. (1975) Polymyositis and Dermatomyositis. New England Journal of Medicine, 292, 403-407. https://doi.org/10.1056/nejm197502202920807 |
| [10] | Cornish, E.F., McDonnell, T. and Williams, D.J. (2022) Chronic Inflammatory Placental Disorders Associated with Recurrent Adverse Pregnancy Outcome. Frontiers in Immunology, 13, Article 825075. https://doi.org/10.3389/fimmu.2022.825075 |
| [11] | 姜丽丽, 刘娜, 段利华. MDA5抗体阳性皮肌炎合并快速进展性肺间质病变的诊治进展[J]. 内科急危重症杂志, 2023, 29(2): 106-111. |
| [12] | Wu, W., Guo, B., Sun, W., Chen, D., Xu, W., Chen, Z., et al. (2025) Effectiveness and Safety of Tofacitinib versus calcineurin Inhibitor in Interstitial Lung Disease Secondary to Anti-MDA5-Positive Dermatomyositis: A Multi-Centre Cohort Study. European Respiratory Journal, 30, Article 2401488. https://doi.org/10.1183/13993003.01488-2024 |
| [13] | Munira, S. and Christopher-Stine, L. (2020) Pregnancy in Myositis and Scleroderma. Best Practice & Research Clinical Obstetrics & Gynaecology, 64, 59-67. https://doi.org/10.1016/j.bpobgyn.2019.10.004 |
| [14] | Goto, H., Kawahata, K., Shida, A., Nakagane, S., Isohata, H., Yamazaki, Y., et al. (2023) Immunosuppressive Therapy before and during Pregnancy May Improve Obstetric Outcomes in Pregnancy Complicated by Dermatomyositis with Anti-MDA-5 Antibody Positivity: A Case Report. Case Reports in Women’s Health, 37, e00479. https://doi.org/10.1016/j.crwh.2023.e00479 |
