Clinical characteristics of invasive pulmonary aspergillosis in patients with dermatomyositis associated with positive anti-melanoma differentiation-associated gene 5 antibody
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.
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