标题：合并间质性肺病皮肌炎患者呼吸衰竭危险因素分析

      作者：颜卫峰 1，陈喆 1，许文兵 2，郭军 3    1.北京市海淀医院呼吸与危重症医学科，北京 100081；2.北京协和医院呼吸与危重症医学科，北京 100010；3.北京清华长庚医院呼吸与危重症医学科，北京 102218

      卷次： 2020年31卷5期

      【摘要】 目的 分析合并间质性肺炎(ILD)的皮肌炎(DM)患者出现呼吸衰竭(RF)的相关危险因素。方法 选取2016年3月至2019年3月间在北京市海淀医院接受治疗的DM合并 ILD患者104例，其中发生RF者42例作为观察组，余62例未发生RF者作为对照组，比较两组患者的临床指标[包含吸烟与否、年龄、皮疹分布、性别、吞咽困难、雷诺现象、皮肤溃疡、外周血中性粒细胞(PMN)发生率、临床无肌病性皮肌炎(CADM)发生率等]、实验室指标[包含循环免疫复合物、外周血细胞计数、血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)、CD4/CD8 T细胞比值、免疫球蛋白 IgG、抗 Jo-1抗体及抗核抗体等]和影像学指标的差异，对有差异的数据行非条件Logistic回归分析。结果 观察组患者的Gottron征比例、PMN发生率、CADM发生率明显高于对照组，差异均有统计学意义(P<0.05)；两组患者的抽烟比例、V-neck征、Shawl征、吞咽困难、关节痛/关节炎、皮肤溃疡及雷诺现象比较，差异均无统计学意义(P>0.05)；观察组患者的血清LDH、AST含量、PLR及NLR比值明显高于对照组，白蛋白含量明显低于对照组，差异均有统计学意义(P<0.05)；两组患者的血清ALT、CK、球蛋白、血红蛋白、WBC含量、CD4+/CD8+比值比较差异均无统计学意义(P>0.05)；两组患者的实变影、胸膜下线、小叶间隔变厚、条索影、胸膜变厚、网格影、支气管扩张及蜂窝影比例比较，差异均无统计学意义(P>0.05)，但观察组患者的磨玻璃影比例明显高于对照组，差异有统计学意义(P<0.05)；非条件Logistic回归分析结果显示，磨玻璃影、CADM及高AST含量为DM合并 ILD患者出现RF的独立危险因素(P<0.05)。结论 DM合并 ILD患者临床诊疗过程中需关注CADM、磨玻璃影、血清AST含量等临床指标，便于提高患者的诊疗效果。
      【关键词】 皮肌炎；间质性肺炎；呼吸衰竭；炎性指标；危险因素
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2020）05—0600—04

Analysis of risk factors for respiratory failure in dermatomyositis patients with interstitial pneumonia.
YANWei-feng 1, CHEN Zhe 1, XU Wen-bing 2, GUO Jun 3. 1.Department of Respiratory and Critical Medicine, Beijing HaidianHospital, Beijing 100081, CHINA; 2. Department of Respiratory and Critical Medicine, Peking Union Medical CollegeHospital, Beijing 100010, CHINA; 3. Department of Respiratory and Critical Medicine, Beijing Tsinghua ChanggengHospital, Beijing 102218, CHINA
【Abstract】 Objective To analyze the risk factors of respiratory failure (RF) in dermatomyositis (DM) patientswith interstitial pneumonia (ILD). Methods A total of 104 patients with DM and ILD who were treated at Beijing Haid-ian Hospital from March 2016 to March 2019 were selected. Among them, 42 patients with RF were selected as the ob-servation group, and the remaining 62 patients without RF were used as the control group. The two groups were com-pared in the following aspects: clinical indicators, including smoking or not, age, rash distribution, gender, dysphagia,Raynaud's phenomenon, skin ulcers, peripheral blood neutrophil (PMN) incidence, clinical non-myogenic dermatomyo-sitis (CADM) incidence, etc.; laboratory indicators, including circulating immune complex, peripheral blood cellcount, platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), lactate dehydrogenase (LDH), aspartateAcid transaminase (AST), CD4/CD8 T-cell ratio, immunoglobulin IgG, anti-Jo-1 antibody, and anti-nuclear antibody,etc.; imaging indicators. Non-conditional logistic regression analysis was performed on the data with significant differ-ences. Results The proportion of Gottron sign, the incidence of PMN, and the incidence of CADM in the observationgroup were significantly higher than those in the control group (P<0.05). The smoking ratio, V-neck sign, Shawl sign,dysphagia, arthralgia/arthritis, skin ulcers, and Raynaud’s phenomenon showed no statistically significant difference be-tween the two groups (P>0.05). The serum LDH, AST content, PLR, and NLR ratios in the observation group were sig-nificantly higher than those in the control group, and the albumin content was significantly lower (P<0.05). There was nosignificant difference in serum ALT, CK, globulin, hemoglobin, WBC content, and CD4 +/CD8 + ratio between the twogroups (P>0.05). There were no significant differences in the proportions of consolidation shadows, subpleural lines, lob-ular septum thickening, cord shadows, pleural thickenings, grid shadows, bronchiectasis, and honeycomb shadows be-