摘要
目的探讨合并间质性肺炎(interstitial lung disease,ILD)的多发性肌炎(polymyositis,PM)/皮肌炎(dermatomyositis,DM)患者的临床、影像学特征及转归。方法回顾分析我院2005年1月1日至2008年12月31日间31例合并ILD的多发性肌炎/皮肌炎患者资料,比较其确诊时的临床表现和胸部高分辨率CT(HRCT)表现及其转归。根据HRCT表现将患者分为两组:第1组主要表现为磨玻璃样变或实变,第2组主要表现为网格状或纤维条索状。结果第1组共10例患者,其中2例生存,8例死亡;第2组共21例患者,其中18例生存,3例死亡。两组间呼吸困难(P=0.015)和初诊时低PaO2(P=0.003)有统计学差异,两组间采用的激素冲击治疗(P=0.045)及结局(P=0.000)亦有明显的统计学差异。Logistic回归分析显示,呼吸困难(OR=0.06,P=0.014)和初诊时低PaO2(OR=1.18,P=0.049)是发生胸部HRCT磨玻璃样变或实变的独立危险因素。肌力水平和肌酶水平在不同的胸部HRCT表现间无明显统计学差异。通过Kaplan-Meier法和Log-rankt检验发现,第1组患者的生存率较第2组差(P=0.000)。结论胸部HRCT表现为磨玻璃样变或实变的患者比表现为纤维条索样变或网格状改变的患者预后要差。
Objective To study the clinical and chest imaging features of chest and the prognosis of patients with interstitial lung disease（ILD） due to polymyositis（PM）/dermatomyositis（DM）. Methods We analyzed the clinical manifestation and high resolution computed tomography（HRCT） manifestation of chest in 31 patients with PM/DM combinding with ILD diagnosed in our hospital from January 1,2005 to December 31,2009.According to the manifestation of HRCT,we separated all the patients into two groups： the HRCT manifestation of patients in the first group was ground-glass change or real change,and the other was linear opacities or grid variable. Results There were 10 patients in the first group with 2 alive and 8 dead.In the scond group,there were 21 patients with 18 alive and 3 dead.We found that there were statistical differences betweem the two groups in dyspnea（P=0.015）,PaO2（P=0.003） at preliminary diagnosis,high-dose steroid pulse therapy（P=0.045） and outcome（P=0.000）.Logistic regression test revealed that dyspnea（OR=0.06,P=0.014） and PaO2（OR=1.18,P=0.049） at preliminary diagnosis were the independent negative factors.There was no statistical difference in the extent of muscle weakness and the level of serum creatase between the two groups.Kaplan-Meier curve and log-rank test showed that the prognosis of the first group was worse than the second group（P=0.000）. Conclusions The prognosis of patients with HRCT manifestation of ground-glass change or real change was worse than those with linear opacities or grid variable HRCT manifestation.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2010年第3期347-351,共5页
Fudan University Journal of Medical Sciences
关键词
多发性肌炎
皮肌炎
间质性肺炎
polymyositis
dermatomyositis
interstitial pneumonia
