CAJ | 학술논문

目的：了解 PM 和 DM 合并肺间质病变（ILD）的临床特点。方法收集并整理114例 PM/DM合并 ILD 患者的临床资料，将其分为 PM-ILD 和 DM-ILD 2组，分析2组患者的一般资料、临床表现、实验室检查、高分辨率 CT（HRCT）、肺功能、血气分析、治疗及转归有无差异，率之间采用四格表χ2检验和 Fisher 确切概率法进行比较。结果 PM/DM-ILD 发病率为35.8%（114/318），DM 较 PM 更易合并 ILD （χ2=5.019，P=0.025）。 PM-ILD 组和 DM-ILD 组在性别构成比上差异有统计学意义（χ2=4.929，P=0.026）；DM-ILD 组患者更易出现关节痛/关节炎（χ2=7.756，P=0.005）；PM 患者 ILD 更易出现于肌炎之前（χ2=15.555，P<0.01），而 DM 患者 ILD 更易出现于肌炎或皮肤表现之后（χ2=7.002，P=0.008）， PM-ILD 组患者更易出现抗 Jo-1抗体阳性（χ2=11.395，P=0.001）。 HRCT 表现上， PM-ILD 组更易出现磨玻璃影（χ2=7.940， P=0.005）和心包积液（χ2=6.322，P=0.012），DM-ILD 组更易出现斑片影（χ2=5.105，P=0.024）；2组患者在肺功能及血气分析上差异无统计学意义；在治疗差异无统计学意义情况下，DM-ILD 组患者的转归明显差于PM-ILD 组（χ2=7.595，P=0.006）。结论 PM-ILD 和 DM-ILD 患者在性别构成、临床表现、实验室检查、影像学表现和转归上差异有统计学意义，因此推测 PM 和 DM 不同的免疫病理机制导致 PM-ILD 和 DM-ILD 具有不同的临床特点。
목적：료해 PM 화 DM 합병폐간질병변（ILD）적림상특점。방법수집병정리114례 PM/DM합병 ILD 환자적림상자료，장기분위 PM-ILD 화 DM-ILD 2조，분석2조환자적일반자료、림상표현、실험실검사、고분변솔 CT（HRCT）、폐공능、혈기분석、치료급전귀유무차이，솔지간채용사격표χ2검험화 Fisher 학절개솔법진행비교。결과 PM/DM-ILD 발병솔위35.8%（114/318），DM 교 PM 경역합병 ILD （χ2=5.019，P=0.025）。 PM-ILD 조화 DM-ILD 조재성별구성비상차이유통계학의의（χ2=4.929，P=0.026）；DM-ILD 조환자경역출현관절통/관절염（χ2=7.756，P=0.005）；PM 환자 ILD 경역출현우기염지전（χ2=15.555，P<0.01），이 DM 환자 ILD 경역출현우기염혹피부표현지후（χ2=7.002，P=0.008）， PM-ILD 조환자경역출현항 Jo-1항체양성（χ2=11.395，P=0.001）。 HRCT 표현상， PM-ILD 조경역출현마파리영（χ2=7.940， P=0.005）화심포적액（χ2=6.322，P=0.012），DM-ILD 조경역출현반편영（χ2=5.105，P=0.024）；2조환자재폐공능급혈기분석상차이무통계학의의；재치료차이무통계학의의정황하，DM-ILD 조환자적전귀명현차우PM-ILD 조（χ2=7.595，P=0.006）。결론 PM-ILD 화 DM-ILD 환자재성별구성、림상표현、실험실검사、영상학표현화전귀상차이유통계학의의，인차추측 PM 화 DM 불동적면역병리궤제도치 PM-ILD 화 DM-ILD 구유불동적림상특점。
Objective To assess if there are differences in clinical features and prognosis of intersti-tial lung disease(ILD) between polymyositis(PM) and dermatomyositis(DM). Methods Medical records of 114 patients with PM/DM(31 PM-ILD, 83 DM-ILD) were reviewed retrospectively to analyze the demograph-ics , clinical manifestations, laboratory findings, high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), blood gas analysis, treatments and prognosis. The differences of measured data were detected by descriptive statisitical analysis, and rates were detected by four-fold table Chi-Square test and Fisher′s exact test. Results The incidence of PM/DM-ILD was 35.8%(114/318) in this study, and DM was more prone to have ILD (χ2=5.019, P=0.025). There were significant difference in sex ratio between PM-ILD and DM-ILD(χ2=4.929, P=0.026). Arthralgia/arthritis was more common in DM-ILD than PM-ILD(χ2=7.756, P=0.005). In PM-ILD, ILD was often present before the diagnosis of PM (χ2=15.555, P<0.01),while it was opposite in DM-ILD(χ2=7.002, P=0.008). The frequency of anti-Jo-1 antibody was higher in PM-ILD than in DM-ILD(χ2=11.395, P=0.001). On HRCT, ground-glass opacity(χ2=7.940, P=0.005) and pericardial effu- <br> sion (χ2=6.322, P=0.012) were more frequently observed in PM-ILD, while patchy shadows were more frequent in DM-ILD (χ2=5.105, P=0.024). There was no difference in PFTs and blood gas analysis between the two groups. With the similar therapeutic regimen, the prognosis of DM-ILD was significantly worse than in PM-ILD (χ2=7.595, P =0.006). Conclusion There are significant differences in sex ratio, clinical manifestations, HRCT imaging findings, and prognosis between PM-ILD and DM-ILD. We propose that the difference in the immunopathological processes of PM and DM leads to different clinical features of ILD between PM and DM.