多肌炎/皮肌炎患者发生间质性肺病的相关因素

作者：Zhang L , et al.

翻译：北医三院黄英

摘要：目的：间质性肺病(ILD)是多发性肌炎 (PM)和皮肌炎 (DM)的肌外表现，可导致很高的发病率和死亡率。本研究目的在于系统评价PM/DM中间质性肺病发生的危险因素。

方法：检索Pubmed、Medline、Embase和 Cochrane Library中的资料。采用混合或随机效应模型计算混合优势比(ORs) 或标准化均值差(SMDs) 和相应的95%置信区间，分析PM/DM中间质性肺病和危险因素之间的关系。还进行了异质性检验、灵敏度分析和发表偏倚的评价。

结果：选出了23项研究进行meta分析，包括834例患者和1245例对照组。可能增加PM/DM患者间质性肺病发生风险的危险因素包括老年人(SMD, 0.35; 95% CI, 0.18-0.52; P < 0.0001)，关节炎或关节痛(or, 3.17; 95% ci, 1.99-5.04; p < 0.00001)，发热 (or, 2.31; 95% ci, 1.42-3.76; p="0.0007)，抗Jo-1抗体阳性" (or, 3.34; 95% ci, 2.16-5.16; p < 0.00001)，红细胞沉降率升高(esr; smd, 0.48; 95% ci, 0.32-0.64; p < 0.00001)，抗mda-5抗体阳性 (or, 18.26; 95% ci, 9.66-34.51; p < 0.00001)，crp水平升高(crp; or, 3.50; 95% ci, 1.48-8.28; p="0.004)。同时，恶性肿瘤(OR," 0.36; 95% ci, 0.18-0.72; p="0.004)" 降低pm/dm患者间质性肺病的发生风险。

结论：Meta分析显示，PM/DM和间质性肺病之间的相关性可能起因于以下危险因素：老年人、关节炎或关节痛、发热、抗Jo-1抗体阳性、ESR升高、抗MDA-5抗体阳性、CRP水平升高，而恶性肿瘤降低间质性肺病的发生风险。因此，这些变量可能可以用于指导筛选PM/DM患者的间质性肺病。

附原文：Abstract OBJECTIVES: Interstitial lung disease (ILD) is an extramuscular manifestation that results in increased morbidity and mortality from polymyositis (PM) and dermatomyositis (DM). The aim of this study was to systematically evaluate risk factors associated with the development of ILD in PM/DM. METHODS: Observational studies were identified from searching PubMed, Medline, Embase, and the Cochrane Library. Pooled odds ratios (ORs) or standardized mean differences (SMDs) and corresponding 95% confidence intervals (CIs) were obtained for the relationships between risk factors and ILD in PM/DM using either fixed- or random-effects models, whichever were appropriate. Heterogeneity tests, sensitivity analyses, and publication bias assessments were also performed.RESULTS:Twenty-three studies were selected for a meta-analysis that included 834 patients and 1245 control subjects. Risk factors that may have increased the risk of developing ILD in PM/DM patients included older age at diagnosis (SMD, 0.35; 95% CI, 0.18-0.52; P < 0.0001), arthritis/arthralgia (or, 3.17; 95% ci, 1.99-5.04; p < 0.00001), fever (or, 2.31; 95% ci, 1.42-3.76; p="0.0007)," presence of anti-jo-1 antibodies (or, 3.34; 95% ci, 2.16-5.16; p < 0.00001), elevated erythrocyte sedimentation rate (esr; smd, 0.48; 95% ci, 0.32-0.64; p < 0.00001), presence of anti-mda5 antibodies (or, 18.26; 95% ci, 9.66-34.51; p < 0.00001), and elevated c-reactive protein level (crp; or, 3.50; 95% ci, 1.48-8.28; p="0.004)." meanwhile, malignancy (or, 0.36; 95% ci, 0.18-0.72; p="0.004)" reduced the risk of developing ild in pm/dm patients.conclusion:our meta-analysis results suggest that the association between pm/dm and ild may be due to such risk factors as older age at diagnosis, arthritis/arthralgia, fever, presence of anti-jo-1 antibodies, elevated esr, presence of anti-mda5 antibodies, and elevated crp level, while malignancy was associated with a reduced risk of developing ild. thus, these variables may be used to guide screening processes for ild in patients with pm/dm.

引自：Zhang L, Wu G, Gao D, Liu G, et al.Factors Associated with Interstitial Lung Disease in Patients with Polymyositis and Dermatomyositis: A Systematic Review and Meta-Analysis. PLoS One. 2016 May 12;11(5):e0155381.