中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

抗氨基酰 tRNA 合成酶抗体阳性的多发性肌炎/皮肌炎患者的临床特征

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目的 探讨抗氨基酰 tRNA 合成酶(ARS)抗体阳性的多发性肌炎/皮肌炎(PM/DM)的临床特征。 方法 回顾性分析 2014 年 9 月至 2017 年 11 月我科诊断的 PM/DM 患者的临床资料,包括临床表现、实验室检查、影像学结果等。 结果 共诊断 39 例 PM/DM 患者,其中抗 ARS 抗体阳性者 24 例(包括抗 Jo-1 抗体阳性者 14 例,非抗 Jo-1 抗体阳性者 10 例),抗 ARS 抗体阴性者 15 例。抗 ARS 抗体阳性者更容易合并肺间质病变(P<0.05),肌无力、技工手表现更常见于抗 Jo-1 抗体阳性的患者(P<0.05),非抗 Jo-1 抗体阳性患者多表现为无肌病的 DM 病程(P<0.05)。 结论 非抗 Jo-1 抗体阳性的抗 ARS 抗体阳性患者与抗 Jo-1 抗体阳性患者的临床症状相似,非特异性间质性肺炎重叠机化性肺炎(NSIP/OP)在抗 Jo-1 抗体阳性的 PM/DM 患者中较为常见。当临床表现为无肌病的 DM 病程且抗 Jo-1 抗体阴性时,需警惕非 Jo-1 抗体综合征。

Objective To describe the clinical characteristics of polymyositis/dermatomyositis (PM/DM) with anti-aminoacyl-tRNA synthetase (ARS) antibody positive. Methods The clinical, laboratory and radiographic results of PM/DM patients hospitalized in our department from September 2014 to November 2017 were retrospectively analyzed. Results A total of 39 patients were diagnosed (14 cases positive for anti-Jo-1 antibody, 10 cases positive for non-anti-Jo-1 ARS antibodies, and 15 negative for ARS antibodies). The frequency of ARS antibodies positive patients who had interstitial lung disease was higher than those patients without ARS antibodies (P<0.05). Amyosthenia and mechanic's hand were more common in the patients with anti-Jo-1 positive (P<0.05) and the frequency of clinical amyopathic dermatomyositis in non-anti-Jo-1 positive patients was significantly higher (P<0.05). Conclusions The clinical characteristics are similar between anti-Jo-1-positive and non-Jo-1 ARS antibodies positive patients. Most PM/DM patients carrying anti-Jo-1 antibodies with interstitial lung disease own typical imaging characteristics of nonspecific interstitial pneumonia overlap organizing pneumonia (NSIP/OP). It can be diagnosed of non-anti-Jo-1 antibody syndrome although there is no clinical manifestation of myositis and anti-jo-1 antibody is negative.

关键词: 多发性肌炎/皮肌炎; 抗氨基酰 tRNA 合成酶抗体; 间质性肺疾病

Key words: Polymyositis/dermatomyositis; Anti-aminoacyl-tRNA synthetase antibody; Interstitial lung diseases

引用本文: 王丽平, 刘斌, 李学任, 彭守春. 抗氨基酰 tRNA 合成酶抗体阳性的多发性肌炎/皮肌炎患者的临床特征. 中国呼吸与危重监护杂志, 2018, 17(6): 570-576. doi: 10.7507/1671-6205.201804038 复制

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1. Hallowell RW, Danoff SK. Interstitial lung disease associated with the idiopathic inflammatory myopathies and the antisynthetase syndrome: recent advances. Curr Opin Rheumatol, 2014, 26(6): 684-689.
2. Chua F, Higton AM, Colebatch AN, et al. Idiopathic inflammatory myositis-associated interstitial lung disease: ethnicity differences and lung function trends in a British cohort. Rheumatology (Oxford), 2012, 51(10): 1870-1876.
3. 陈小波, 罗群, 李时悦. 以急性间质性肺炎为主要症状的多发性肌炎/皮肌炎八例并文献复习. 中国呼吸与危重监护杂志, 2016, 15(6): 589-592.
4. Katzap E, Barilla-LaBarca ML, Marder G. Antisynthetase syndrome. Curr Rheumatol Rep, 2011, 13(3): 175-181.
5. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med, 1975, 292(7): 344-347.
6. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med, 1975, 292(8): 403-407.
7. Sontheimer RD. Would a new name hasten the acceptance of amyopathic dermatomyositis (dermatomyositis siné myositis) as a distinctive subset within the idiopathic inflammatory dermatomyopathies spectrum of clinical illness?. J Am Acad Dermatol, 2002, 46(4): 626-636.
8. Sato S, Kuwana M. Clinically amyopathic dermatomyositis. Curr Opin Rheumatol, 2010, 22(6): 639-643.
9. Won Huh J, Soon Kim D, Keun Lee C, et al. Two distinct clinical types of interstitial lung disease associated with polymyositis-dermatomyositis. Respir Med, 2007, 101(8): 1761-1769.
10. Koenig M, Fritzler MJ, Targoff IN, et al. Heterogeneity of autoantibodies in 100 patients with autoimmune myositis: insights into clinical features and outcomes. Arthritis Res Ther, 2007, 9(4): R78.
11. Watanabe K, Handa T, Tanizawa K, et al. Detection of antisynthetase syndrome in patients with idiopathic interstitial pneumonias. Respir Med, 2011, 105(8): 1238-1247.
12. Gomard-Mennesson E, Fabien N, Cordier JF, et al. Clinical significance of anti-histidyl-tRNA synthetase (Jo1) autoantibodies. Ann N Y Acad Sci, 2007, 1109(1): 414-420.
13. Hervier B, Devilliers H, Benveniste O. Patients with non-Jo-1 anti-RNA-synthetase autoantibodies have worse survival than Jo-1 positive patients. Ann Rheum Dis, 2013, 72(7): e18.
14. Sontheimer RD. MDA5 autoantibody-another indicator of clinical diversity in dermatomyositis. Ann Transl Med, 2017, 5(7): 160.
15. Lega JC, Fabien N, Reynaud Q, et al. The clinical phenotype associated with myositis-specific and associated autoantibodies: a meta-analysis revisiting the so-called antisynthetase syndrome. Autoimmun Rev, 2014, 13(9): 883-891.
16. 林舒缓. 17 例抗 Jo-1 抗体综合征临床分析及文献复习[D]. 福建医科大学, 2012.
17. Solomon J, Swigris JJ, Brown KK. Myositis-related interstitial lung disease and antisynthetase syndrome. J Bras Pneumol, 2011, 37(1): 100-109.
18. Zamora AC, Hoskote SS, Abascal-Bolado B, et al. Clinical features and outcomes of interstitial lung disease in anti-Jo-1 positive antisynthetase syndrome. Respir Med, 2016, 118: 39-45.
19. Tillie-Leblond I, Wislez M, Valeyre D, et al. Interstitial lung disease and anti-Jo-1 antibodies: difference between acute and gradual onset. Thorax, 2008, 63(1): 53-59.
20. Koreeda Y, Higashimoto I, Yamamoto M, et al. Clinical and pathological findings of interstitial lung disease patients with anti-aminoacyl-tRNA synthetase autoantibodies. Intern Med, 2010, 49(5): 361-369.
21. Douglas WW, Tazelaar HD, Hartman TE, et al. Polymyositis-dermatomyositis-associated interstitial lung disease. Am J Respir Crit Care Med, 2001, 164(7): 1182-1185.
22. Antin-Ozerkis D, Rubinowitz A, Evans J, et al. Interstitial lung disease in the connective tissue diseases. Clin Chest Med, 2012, 33(1): 123-149.
23. Marie I, Josse S, Decaux O, et al. Comparison of long-term outcome between anti-Jo1-and anti-PL7/PL12 positive patients with antisynthetase syndrome. Autoimmun Rev, 2012, 11(10): 739-745.
24. Hervier B, Devilliers H, Stanciu R, et al. Hierarchical cluster and survival analyses of antisynthetase syndrome: phenotype and outcome are correlated with anti-tRNA synthetase antibody specificity. Autoimmun Rev, 2012, 12(2): 210-217.