摘要目的 探讨多发性肌炎/皮肌炎(PM/DM)患者发生间质性肺疾病(ILD)的相关因素及影响预后的不良因素.方法 以上海第二军医大学长海医院1997年1月至2006年11月收住的PM/DM患者87例为研究对象,分为ILD组40例(男13例,女27例),平均年龄(54±13)岁;非ILD组47例(男25例,女22例),平均年龄(45±18)岁.对ILD的发生率、临床特征和预后进行分析.正态分布的计量资料采用t检验,偏态分布的计量资料采用秩和检验,计数资料两组率的比较采用x2检验,PM/DM伴发ILD的预测因素和预后不良因素采用logistic回归分析和Kaplan-Meier生存曲线.结果 PM/DM中ILD的发生率为46％(40/87),病死率为40％(16/40).ILD组的平均年龄[(54±13)岁]明显大于非ILD组[(45±18)岁];ILD组出现发热(21/40)、吞咽困难(16/40)、关节痛(26/40)、Gottron皮疹(14/40)和心脏损害(26/40)的百分率明显高于非ILD组(分别为7/47、8/47、9/47、2/47和14/47);ILD组的血清乳酸脱氢酶[(472±285)IU]和ESR[(44 ±24)mm/1 h]明显高于非ILD)组[(310±238)IU和(26±24)mm/1 h];ILD组的IgG[(18±9)g/L]明显高于非ILD组[(14±5)g/L].经多因素非条件logistic回归分析,筛选出4个与ILD相关的预测因子:Gottron皮疹、关节痛、发热和年龄≥40岁,其相对危险度分别为12.048、7.812、6.329和5.236;生存分析结果显示,Gottron皮疹、心脏损害和肺间质病变是影响ILD预后的不良因素.结论 PM/DM患者年龄≥40岁,出现Gottron皮疹、关节痛和发热与ILD的发生密切相关,Gottron皮疹、心脏损害和肺间质病变是影响ILD预后的不良因素.

abstractsObjective To analyze the predictive factors and the unfavourable prognostic factors of interstitial lung disease (ILD) in patients with polymyositis (PM)/dermatomyositis(DM).Methods The clinical data were collected from 87 inpatients with DM or PM,who were admitted to Shanghai Chanshai Hospital from January 1997 to November 2006.The patients were divided into an ILD group and a non-ILD group.The clinical feature.ineidence and prognosis of ILD were retrospectively analyzed.The clinical and laboratory data were analyzed by using the SPSS 13.0 software.The t-test and rank-sum test were used.depending on the measurement data.The enumeration data were analyzed with chi-square test.Logistic regression and Kaplan-Meier sunrival curve were used to analyze the correlative and prognostic factors of interstitial lung disease (ILD) in patients with PM/DM.Results The incidence and mortality of ILD in PM/DM patients were 46％(40/87)and 40％(16/40),respectively.Compared with the non-ILD group,the age in the ILD group was markedly older[(54 ±13) years vs (45±18) years],and the percentages of fever (21/40 vs 7/47,x2=14.00,P＜0.01),dysphagia(16/40 vs 8/47,x2=5.71,P＜0.05),arthralgia (26/4 vs 9/47,X2=18.89,P＜0.01).Gottron's rash (14/40 vs 2/47,x2:13.61,P＜0.01) and heart impairment(26/40 vs 14/47,x2=10.28,P＜0.01) were significantly higher in the ILD group.The levels of LDH [(472 ±285) IU vs (310±238) IU,t=2.86,P＜0.01],ESR [(44±24)mm/1 h vs (26±24)mm/1 h,t=3.19,P＜0.01] and immunoglobulin G[(18 ±9)s/L vs (14 ±5)g/L,t=2.31,P＜0.05] were statistically different between the two groups.By multivariate nonparametric logistic regression analysis,Gottron's rash,arthralgia,fever,and≥40 years of age were identified as predictors with relative risk ratio of 12.048,7.812,6.329 and 5.236 respectively.The unfavourable prognostic factors ofILD were Gottron's rash (x2=5.35,P＜0.05),cardiac impairment (x2=5.68,P＜0.05)and pulmonary fibrosis (x2=5.42,P＜0.05) by survival analysis.Conclusion The occurrence of ILD in PM/DM patients was closely correlated to Gottron's rash,age≥40 years,arthralgia and fever.Gottron's rash,heart impairment and pulmonary fibrosis were poor prognosis factors of PM/DM patients complicated with ILD.