抗黑色素瘤分化相关基因5抗体阳性皮肌炎合并侵袭性肺曲霉菌病临床特征及危险因素分析
Clinical characteristics of invasive pulmonary aspergillosis in patients with dermatomyositis associated with positive anti-melanoma differentiation-associated gene 5 antibody
陈西霞 1王国春 2葛勇鹏2
作者信息
- 1. 北京大学中日友好临床医学院,北京 100029
- 2. 中日友好医院风湿免疫科,北京 100029
- 折叠
摘要
目的 探讨抗黑色素瘤分化相关基因5(MDA5)抗体阳性皮肌炎(MDA5-DM)合并侵袭性肺曲霉菌病(IPA)的临床特征、危险因素及预后.方法 收集2020年1月至2022年6月于中日友好医院风湿免疫科住院治疗的MDA5-DM患者55例,根据是否合并IPA分为2组:IPA(+)组(14例)和IPA(-)组(41例).回顾性分析患者微生物学检查结果及临床资料.2组正态分布计量资料比较采用t检验,非正态分布的计量资料比较采用Mann-Whitney U检验,计数资料比较采用x2检验.危险因素分析采用二元Logistic回归,生存分析采用Kaplan-Meier法.结果 IPA(+)组患者以感染黄曲霉(5/14,35.7％)和烟曲霉(4/14,28.6％)最为常见.与IPA(-)组相比,IPA(+)组患者具有更高的α羟丁酸脱氢酶[246.0(160.3,328.3)U/L 与 191.0(167.0,227.5)U/L,Z=-2.02,P=0.043]和血清铁蛋白[1 306.7(518.7,2 977.8)ng/ml与 472.6(269.0,792.1)ng/ml,Z=-2.09,P=0.036],更低的 CD8+T 细胞计数[111.5(68.3,214.0)×106/L 与188.0(141.0,270.0)×106/L,Z=-2.18,P=0.029),且支气管肺泡灌洗液半乳糖甘露聚糖试验阳性更多见[70.0％(7/10)与18.9％(7/37),x2=9.82,P=0.004].多因素分析发现血清铁蛋白升高是发生IPA的独立危险因素[调整后OR值(95％C/)=1.001(1.000,1.002),P=0.031].生存分析结果示IPA(+)组的6个月累积生存率显著低于IPA(-)组(78.6％与97.6％,P=0.021).结论 MDA5-DM患者感染IPA后死亡率高,血清铁蛋白升高是发生IPA的独立危险因素,积极预防和治疗IPA有望改善患者预后.
Abstract
Objective To investigate the clinical characteristics,risk factors,and prognosis of invasive pulmonary aspergillosis(IPA)in patients with dermatomyositis associated with positive anti-melanoma differen-tiation-associated gene 5(MDA5-DM).Methods A total of 55 patients with MDA5-DM were analyzed.Patients were divided into IPA(+)group(14 cases)and IPA(-)group(41 cases)based on the presence of IPA.Microbiological examination and clinical data were analyzed.Risk factor analysis was performed using Binary Logistic regression,and survival analysis was carried out using Kaplan-Meier method.Results Aspergillus flavus(5/14,35.7％)and Aspergillus fumigatus(4/14,28.6％)were the most common species in MDA5-DM patients with IPA.Compared to the IPA(-)group,IPA(+)group had higher serum level of α-hydroxybutyrate dehydrogenase(246 U/L vs.191 U/L,Z=-2.02,P=0.043)and ferritin[1 306.7(518.7,2 977.8)ng/ml vs.472.6(269.0,792.1)ng/ml,Z=-2.09,P=0.036],lower CD8+T lymphocyte counts {[111.5(68.3,214.0)]×106/L vs.[188.0(141.0,270.0)]×106/L,Z=-2.18,P=0.029 },and more positive BALF GM tests[70.0％(7/10)vs.18.9％(7/37),x2=9.82,P=0.004].Elevated serum ferritin was found to be an independent risk factor for IPA occurrence[adjusted OR(95％CI)=1.001(1.000,1.002),P=0.031)].In addition,the 6-month cumulative survival rate was significantly lower in the IPA(+)group than in the IPA(-)group(78.6％vs.97.6％,P=0.021).Conclusion The mortality of MDA5-DM patients is increased after IPA infection.Elevated serum ferritin is an independent risk factor for IPA occurrence,and active prevention and treatment of IPA are expected to improve the prognosis of patients.
关键词
皮肌炎/侵袭性肺曲霉菌病/危险因素/抗MDA5抗体Key words
Dermatomyositis/Invasive pulmonary aspergillosis/Risk factors/Anti-MDA5 antibody引用本文复制引用
基金项目
中央高水平医院临床科研业务费(2022-NHLHCRF-YS-02)
中日友好医院"菁英计划"人才培育工程(ZRJY2023-GG02)
出版年
2024
NETL
NSTL
万方数据