Objective To investigate the clinical features and prognosis of male with anti-melanoma differentiation-associated gene 5(MDA5)autoantibody.Methods The clinical data of 246 patients with DM and anti-MDA5 autoantibodies hospitalized by Jiangsu Myositis Cooperation Group from 2017 to 2020 were collected and retrospectively analyzed.Chi-square test was performed to compared between counting data groups;Quantitative data were expressed by M(Q1,Q3),and rank sum test was used for comparison between groups;Single factor survival analysis was performed by Kaplan-Meier method and Log rank test;Cox regression analysis were used for multivariate survival analysis.Results ① The male group had a higher proportion of rash at the sun exposure area[67.1％(47/70)vs 52.8％(93/176),x2=4.18,P=0.041]and V-sign[50.0％(35/70)vs 30.7％(54/176),x2=8.09,P=0.004]than the female group.The male group had higher levels of creatine kinase[112(18,981)U/L vs 57(13.6,1 433)U/L,Z=-3.50,P＜0.001]and ferritin[1 500(166,32 716)ng/ml vs 569(18,14 839)ng/ml,Z=-5.85,P＜0.001]than the female group.The proportion of ILD[40.0％(28/70)vs 59.7％(105/176),x2=7.82,P=0.020]patients and the red blood cell sedimentation rate[31.0(4.0,101.5)mm/1 h vs 43.4(5.0,126.5)mm/1 h,Z=-2.22,P=0.026]in the male group was lower than that of the female group,but the proportion of rapidly progressive interstitial lung disease(PR-ILD)[47.1％(33/70)vs 31.3％(55/176),x2=5.51,P=0.019]was higher than that of the female group.②In male patients with positive anti-MDA5 antibodies,the death group had a shorter course of disease[1.0(1.0,3.0)month vs 2.5(0.5,84)month,Z=-3.07,P=0.002],the incidence of arthritis[16.7％(4/24)vs 42.2％(19/45),x2=4.60,P=0.032]were low than those in survival group,while aspartate aminotransferase(AST)[64(22.1,565)U/L vs 51(14,601)U/L,Z=-2.42,P=0.016],lactate dehydrogenase(LDH)[485(24,1 464)U/L vs 352(170,1 213)U/L,Z=-3.38,P=0.001],C-reactive protein(CRP)[11.6(2.9,61.7)mg/Lvs 4.95(0.6,86.4)mg/L,Z=-1.96,P=0.050],and ferritin levels[2 000(681,7 676)vs 1 125(166,32 716)ng/ml,Z=-3.18,P=0.001]were higher than those in the survival group,and RP-ILD[95.8％(23/24)vs 22.2％(10/45),x2=33.99,P＜0.001]occurred at a significantly higher rate.(3)Cox regression analysis indicated that the course of disease LDH level,and RP-ILD were related factors for the prognosis of male anti-MDA5 antibodies[HR(95％CI)=0.203(0.077,0.534),P=0.001;HR(95％CI)=1.002(1.001,1.004),P=0.003;HR(95％CI)=95.674(10.872,841.904),P＜0.001].Conclusion The clinical manifestations of male anti-MDA5 antibody-positive patients are different from those of female.The incidence of ILD is low,but the proportion of PR-ILD is high.The course of disease,serum LDH level,and RP-ILD are prognostic factors of male anti-MDA5 antibody-positive patients.
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