摘要
目的分析合并间质性肺炎(ILD)的皮肌炎(DM)患者出现呼吸衰竭(RF)的相关危险因素。方法选取2016年3月至2019年3月间在北京市海淀医院接受治疗的DM合并ILD患者104例,其中发生RF者42例作为观察组,余62例未发生RF者作为对照组,比较两组患者的临床指标[包含吸烟与否、年龄、皮疹分布、性别、吞咽困难、雷诺现象、皮肤溃疡、外周血中性粒细胞(PMN)发生率、临床无肌病性皮肌炎(CADM)发生率等]、实验室指标[包含循环免疫复合物、外周血细胞计数、血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)、CD4/CD8 T细胞比值、免疫球蛋白IgG、抗Jo-1抗体及抗核抗体等]和影像学指标的差异,对有差异的数据行非条件Logistic回归分析。结果观察组患者的Gottron征比例、PMN发生率、CADM发生率明显高于对照组,差异均有统计学意义(P<0.05);两组患者的抽烟比例、V-neck征、Shawl征、吞咽困难、关节痛/关节炎、皮肤溃疡及雷诺现象比较,差异均无统计学意义(P>0.05);观察组患者的血清LDH、AST含量、PLR及NLR比值明显高于对照组,白蛋白含量明显低于对照组,差异均有统计学意义(P<0.05);两组患者的血清ALT、CK、球蛋白、血红蛋白、WBC含量、CD4+/CD8+比值比较差异均无统计学意义(P>0.05);两组患者的实变影、胸膜下线、小叶间隔变厚、条索影、胸膜变厚、网格影、支气管扩张及蜂窝影比例比较,差异均无统计学意义(P>0.05),但观察组患者的磨玻璃影比例明显高于对照组,差异有统计学意义(P<0.05);非条件Logistic回归分析结果显示,磨玻璃影、CADM及高AST含量为DM合并ILD患者出现RF的独立危险因素(P<0.05)。结论 DM合并ILD患者临床诊疗过程中需关注CADM、磨玻璃影、血清AST含量等临床指标,便于提高患者的诊疗效果。
Objective To analyze the risk factors of respiratory failure(RF) in dermatomyositis(DM) patients with interstitial pneumonia(ILD). Methods A total of 104 patients with DM and ILD who were treated at Beijing Haidian Hospital from March 2016 to March 2019 were selected. Among them, 42 patients with RF were selected as the observation group, and the remaining 62 patients without RF were used as the control group. The two groups were compared in the following aspects: clinical indicators, including smoking or not, age, rash distribution, gender, dysphagia,Raynaud’s phenomenon, skin ulcers, peripheral blood neutrophil(PMN) incidence, clinical non-myogenic dermatomyositis(CADM) incidence, etc.;laboratory indicators, including circulating immune complex, peripheral blood cell count, platelet/lymphocyte ratio(PLR), neutrophil/lymphocyte ratio(NLR), lactate dehydrogenase(LDH), aspartate Acid transaminase(AST), CD4/CD8 T-cell ratio, immunoglobulin IgG, anti-Jo-1 antibody, and anti-nuclear antibody,etc.;imaging indicators. Non-conditional logistic regression analysis was performed on the data with significant differences. Results The proportion of Gottron sign, the incidence of PMN, and the incidence of CADM in the observation group were significantly higher than those in the control group(P<0.05). The smoking ratio, V-neck sign, Shawl sign,dysphagia, arthralgia/arthritis, skin ulcers, and Raynaud ’s phenomenon showed no statistically significant difference between the two groups(P>0.05). The serum LDH, AST content, PLR, and NLR ratios in the observation group were significantly higher than those in the control group, and the albumin content was significantly lower(P<0.05). There was no significant difference in serum ALT, CK, globulin, hemoglobin, WBC content, and CD4+/CD8+ratio between the two groups(P>0.05). There were no significant differences in the proportions of consolidation shadows, subpleural lines, lobular septum thickening, cord shadows, pleural thickenings, grid shadows, bronchiectasis, and honeycomb shadows between the two groups(P>0.05). However, the proportion of ground glass shadow in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). The results of non-conditional logistic regression analysis showed that ground glass shadow, late age of onset, CADM, and high AST content were independent risk factors of RF in patients with DM and ILD(P<0.05). Conclusion In the clinical diagnosis and treatment of patients with DM and ILD, clinical indicators such as CADM, ground glass shadow, and serum AST content should be paid attention to in order to improve the diagnosis and treatment of patients.
作者
颜卫峰
陈喆
许文兵
郭军
YAN Wei-feng;CHEN Zhe;XU Wen-bing;GUO Jun(Department of Respiratory and Critical Medicine,Beijing Haidian Hospital,Beijing 100081,CHINA;Department of Respiratory and Critical Medicine,Peking Union Medical College Hospital,Beijing 100010,CHINA;Department of Respiratory and Critical Medicine,Beijing Tsinghua Changgeng Hospital,Beijing 102218,CHINA)
出处
《海南医学》
CAS
2020年第5期600-603,共4页
Hainan Medical Journal
关键词
皮肌炎
间质性肺炎
呼吸衰竭
炎性指标
危险因素
Dermatomyositis
Interstitial pneumonia
Respiratory failure
Inflammatory indicators
Risk factors
作者简介
通讯作者:颜卫峰,E-mail:yanweifeng_1129@126.com。
