Analysis Of Clinical Characteristics And Predictive Factors In Patients With Anti-synthetase Syndrome Associated With Interstitial Lung Disease

Objective:In order to deepen clinicians’ understanding of anti-synthetase syndrome associated with interstitial lung disease（ASS-ILD）and improve early diagnosis by summarizing and analyzing the clinical characteristic of patients with ASS-ILD.Methods:A total of 64 patients with ASS-ILD diagnosed for the first time in the Department of Respiratory Medicine of the second Hospital of Jilin University from January 2016 to December 2021 were retrospectively reviewed.The basic data,clinical symptoms and sings,laboratory indexes,pulmonary function indexes,imaging examination and treatment regimen were collected.According to the difference of anti-aminoacyl t RNA（ARS）antibodies,the patients were divided into four subtypes: anti-Jo-1antibody positive,anti-PL-12 antibody positive,anti-EJ antibody positive and anti-PL-7 antibody positive.Statistical software was used for the comparative analysis between groups.Results:（1）The average age of ASS-ILD patients was（57.81±12.34）years,and the course of disease was 4.00（1.00,17.00）months,including 24males（37.5%）and 40females（62.5%）.The main type of anti-ARS antibody was anti-Jo-1 antibody positive（39cases,60.9%）.There was no significant difference in age,course of disease and sex constituent ratio among different subtypes of patients（P>0.05）.（2）Respiratory symptoms were the first manifestation of ASS-ILD patients（60cases,93.8%）,and there were significant differences among different subtypes of patients with respiratory symptoms（P<0.05）.The most common respiratory symptoms of ASS-ILD patients were dyspnea in 52 cases（81.3%）,cough in 43 cases（67.2%）,expectoration in 37 cases（57.8%）and fever in 17 cases（26.6%）.The most common sign was 25 cases（39.1%）of craftman’s hand.There was no significant difference in clinical manifestations among different subtypes of patients（P>0.05）.（3）There was no significant difference in leukocyte,erythrocyte sedimentation rate,hypersensitive C-reactive protein,creatine kinase and lactate dehydrogenase among different subtypes of ASS-ILD.Among myositis related antibodies,the positive rate of Ro52 antibody in patients with ASS-ILD was high,and the expression of Ro52 antibody in different subtypes was significantly different（P<0.01）.（4）The main changes of pulmonary function in patients with ASS-ILD were limitation of pulmonary ventilation function and decrease of diffusion function,and there was no significant difference in pulmonary function indexes among different subtypes（P>0.05）.（5）The common HRCT changes in ASS-ILD patients were ground glass shadow（90.6%）,grid shadow（75.0%）,stripe shadow（54.7%）,subpleural line（29.7%）,traction bronchiectasis（28.1%）and honeycomb sign（26.6%）.The incidence of traction bronchiectasis and subpleural line in patients with positive anti-EJ antibody was significantly higher than that of other three subtypes（P<0.05）.There was no significant difference in other imaging findings among the four subtypes（P>0.05）.（6）The most common imaging characteristic of ASS-ILD patients was nonspecific interstitial pneumonia（NSIP）（54.7%）.There was no significant difference in imaging characteristic among different subtypes of patients（P>0.05）.（7）Of the patents with ASS-ILD,57 cases（89.1%）were treated with glucocorticoid,46 cases（71.9%）were treated with glucocorticoid combined with immunosuppressant,and 11 cases（17.2%）were treated with glucocorticoid monotherapy.There were significant differences among the four subtypes of glucocorticoid along,glucocorticoid combined with cyclosporine and glucocorticoid combined with tacrolimus（P<0.05）.There was no significant difference in other treatment schemes among different subtypes（P>0.05）.59 patients（92.2%）were improved and discharged after treatment.Two patients with positive anti-Jo-1antibody died of severe pneumonia,one patient with positive anti-Jo-1 antibody,one patient with positive anti-EJ antibody and one patient with positive anti-PL-7antibody died of respiratory failure.Conclusions:1、Anti-Jo-1 antibody positive was the most common subtype of ASS-ILD.2、Ro52 antibody positive might be a predictor of early diagnosis of ASS-ILD.3、The main imaging feature of ASS-ILD was nonspecific interstitial pneumonia.