| Objective:This study explored the clinical features and risk factors of polymyositis(PM)and dermatomyositis(DM),PM/DM combined with interstitial lung disease(ILD)and PM/DM combined with malignancy in an effort to provide evidence for clinical diagnosis,treatment and prognostic evaluation of PM/DM patients,and increase the diagnosis rate and improve patient management,potentially improving treatment outcomes of PM/DM patients combined with ILD and malignancy.Methods:1.Data were collected from 119 patients with PM/DM,treated at the Affiliated Hospital of North Sichuan Medical College from January 1,2014 to June 30,2018,and retrospectively contrast analyzed their general medical status,misdiagnosis,clinical symptoms,laboratory indicators,High-resolution computed tomography(HRCT)scans,therapeutic outcomes and prognoses by dividing the patients into PM and DM groups;2.General medical status,clinical symptoms,laboratory indicators,high-resolution computed tomography(HRCT)scans,therapeutic outcomes,and prognoses were retrospectively reviewed by dividing the 119 patients into 2 groups.The ILD group consisted of patients with PM/DM-ILD.The remaining patients with PM/DM were assigned to the“no ILD”(NILD)group.Bivariate logistic regression was used to determine independent risk factors for ILD in this population;3.General medical status,clinical symptoms,laboratory indicators,therapeutic outcomes,and prognoses were retrospectively reviewed by dividing the 117 patients(two patients with suspected malignancies whose primary lesions could not be found were screened out)into malignancy group and non-malignancy group.Bivariate logistic regression was used to determine independent risk factors for malignancy in this population;4.t-test,Mann-Whitney,Chi-square(?~2)test,Fisher's exact test and Bivariate logistic regression were used for statistical analysis.Results:1.Clinical and laboratory characteristics of PM and DM patients in the northeast Sichuan province of Chinawere compared:There were no statistically significant differences in sex,age and disease duration between the PM group(n=53)and DM(n=66)group(P>0.05 for all).The incipient symptom in 66%(35/53)of PM patients was myasthenia(P<0.05),and the incipient symptom in 40.9%(35/66)of DM patients was rash.The incidence of limb proximal muscle weakness,raynaud's phenomenon and dry cough in PM group were higher than that of the DM group(P>0.05 for all).The elevated aspartate transferase(AST),alanine transaminase(ALT),creatine kinase(CK),CK-MB,hydroxybutyrate dehydrogenase(HBDH),lactate dehydrogenase(LDH),white blood cell(WBC)count and high sensitivity C reactive protein(hsCRP)in PM group were all higher than that of the DM group(P<0.05 for all).PM groupantinuclear antibodies(ANA)and anti-Jo-1 antibodypositive rate were higher than that of the DM group(P<0.05for all).HRCT showed that PM patients combine with interstitial lung disease(PM-ILD)had higher incidence of reticular opacity than DM patients combine with interstitial lung disease(DM-ILD)(P<0.05).The incidence of PM-ILD was higher than DM-ILD(54.7%versus 47%),but had a lower death rate.The incidence of DM patients with other connective tissue diseases higher than PM group(18.87%versus 9.1%).2.Clinical characteristics and influence factors of PM/DM patients combined with ILD in the northeast Sichuan province of China were compared:There was statistically significant difference in age between the ILD group(n=60)and the NILD group(n=59)(P<0.05),but no significant differences in PM/DM ratio,sex,or disease duration(P>0.05 for all).Initial symptoms of the ILD group were arthritis and respiratory symptoms(P<0.05for all),whereas the initial symptom of patients in the NILD group was myasthenia(P<0.05).Incidences of Raynaud's phenomenon,dry cough,dyspnea on exertion,arthritis,and fever were higher for patients in the ILD group,compared to the NILD group(P<0.05 for all).The ILD group had significantly higher globulin(GLOB),erythrocyte sedimentation rate(ESR),and anti-Jo-1 antibody rate compared to the NILD group(P<0.05 for all);however,albumin(ALB),creatine kinase aspartate aminotransferase activity ratio(CK/AST)and CK were significantly lower in the ILD group(P<0.05for all).Bivariate logistic regression analysis showed that age(OR 1.061,95%CI 1.022-1.102),dry cough(OR 2.622,95%CI 1.039-6.616),arthritis(OR3.257,95%CI 1.224-8.666),dyspnea on exertion(OR 3.145,95%CI1.134-8.718),anti-Jo-1 antibody(OR 3.777,95%CI 1.133-12.587),and elevated GLOB(OR 1.09,95%CI1.029-1.055)were independent risk factors for developing ILD among patients with PM/DM.3.Clinical features and associated influence factors of PM/DM with malignant tumors in the northeast Sichuan province of China were compared:There was statistically significant difference in age between malignancy group(n=14)and non-malignancy group(n=103)(P<0.05),and no significant differences in sex raito,disease duration.Among the 14patients with malignant tumors,lung cancer was the most common clinical type(3/14),and adenocarcinoma was the most common pathological type(9/12).The incident of model skin rash such as Heliotrop rash,V-shaped rash in the neck and chest area and Gottron's sign in malignancy group were all higher than that of the non-malignancy group(P<0.01 for all),and The incident ofarthritis was lower than non-malignancy group(P<0.05).The elevated ESR in malignancy group were higher than non-malignancy group(P<0.01),but the GLOB were lower than that of the non-malignancy group(P<0.01).Bivariate logistic regression analysis showed that model skin rash(OR8.404,95%CI 1.614-43.747)and elevated ESR(OR1.054,95%CI1.020-1.089)were the independent risk factors for developing malignancy in patients with PM/DM,and the elevated GLOB(OR 0.784,95%CI 0.666-0.922)was the protective factor for developing malignancy in patients with PM/DM.Conclusion:1.The incipient symptom of PM and DM were myasthenia and rash,respectively.Differences in the limb proximal muscle weakness,raynaud's phenomenon,dry cough,CK,CK-MB,HBDH,LDH,WBC,hsCRP,antinuclear antibodiespositive rate,anti-Jo-1 antibodypositive rateand HRCT of lung between PM and DM groups were noted in this study.2.The morbidity of PM/DM-ILD is high,and is the leading cause of death in patients with PM/DM.3.PM-ILD had higher incidence than DM-ILD,but shows lower death rate.4.In particular,those who are older,have a dry cough,arthritis,dyspnea on exertion,anti-Jo-1 antibody positivity,and increased GLOB are at increased risk of developing ILD;therefore,this information could be used to carefully monitor lung function and HRCT images of lung changes in these patients.5.PM/DM is easy to be associated with malignancy.The most common clinical type of malignancy was lung cancer,and the most common pathological type was adenocarcinoma.The incidence of DM combined with malignancy was higher than PM.6.PM/DM patients who combined with malignancy was commom in elderly and no joint involvementpatients.The model skin rash and elevated ESR were the independent risk factors for developing malignancy in patients with PM/DM,and the elevated GLOB was the protective factor.Therefore,PM/DM patients who presenting the above symptoms and serologic results should be screened for malignancy closely. |
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