中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (6): 480-484.doi: 10.35541/cjd.20200683

• 论著 • 上一篇    下一篇

成人皮肌炎患者抗核抗体与临床特征及肿瘤风险的关系

杨长志    张晓萍    杨子良    周乃慧    朱丽萍    邵凯    朱婷婷    余秀琴    

  1. 苏州大学附属第一医院皮肤性病科  215000
  • 收稿日期:2020-07-06 修回日期:2021-01-15 发布日期:2021-05-31
  • 通讯作者: 杨长志 E-mail:yangchangzhi860907@163.com

Association of antinuclear antibody status with clinical features and malignancy risk in adult patients with dermatomyositis

Yang Changzhi, Zhang Xiaoping, Yang Ziliang, Zhou Naihui, Zhu Liping, Shao Kai, Zhu Tingting, Yu Xiuqin   

  1. Department of Dermatology and Venereology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
  • Received:2020-07-06 Revised:2021-01-15 Published:2021-05-31
  • Contact: Yang Changzhi E-mail:yangchangzhi860907@163.com

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摘要： 【摘要】 目的 探讨成人皮肌炎患者抗核抗体与临床特征及肿瘤风险的关系。方法 回顾性分析2008年4月至2018年4月在苏州大学附属第一医院皮肤科住院的101例皮肌炎患者的临床资料，分为抗核抗体阳性组和阴性组，比较两组之间肌病、肿瘤发生风险以及其他临床特征的差异。92例患者随访2年。采用卡方检验分析比较两组的临床特征，利用多因素回归分析模型分析抗核抗体和无肌病性皮肌炎及肿瘤之间的关系。结果 101例皮肌炎患者中，男42例，女59例，年龄（55.13 ± 14.63）岁；无肌病性皮肌炎14例，低肌病性皮肌炎6例，肌病性皮肌炎81例；抗核抗体阳性42例（41.58%），阴性59例（58.41%）。抗核抗体阳性组颈部红斑（33.33%比59.32%，P = 0.010）、披肩征（14.28%比35.59%，P = 0.017）发生率低于阴性组。皮肌炎合并肿瘤28例（27.72%）。抗核抗体阳性者5例（11.9%）发生肿瘤，阴性者23例（38.98%）发生肿瘤。单因素分析显示，抗核抗体阴性皮肌炎患者发生肿瘤的相对危险度估计值比值比为7.52（95% CI 1.62 ~ 13.78，P = 0.003）。在多因素回归模型中，抗核抗体阴性（OR值4.34，95% CI 1.37 ~ 13.72，P = 0.012）和颈部红斑（OR = 3.27，95% CI 1.20 ~ 8.91，P = 0.020）与肿瘤高发概率显著相关，抗核抗体阴性与无肌病性皮肌炎的发生无统计学相关性（OR = 0.99，95% CI 0.32 ~ 2.99，P = 0.980）。结论 抗核抗体阴性且伴颈部红斑的成人皮肌炎患者发生肿瘤的风险明显增加，有必要对这类皮肌炎患者进行密切随访和定期肿瘤筛查。

关键词: 皮肌炎, 抗体, 抗核, 肿瘤, V形红斑

Abstract: 【Abstract】 Objective To investigate the relationship of antinuclear antibody （ANA） status with clinical features and malignancy risk in adult patients with dermatomyositis. Methods A retrospective analysis was performed to analyze clinical data from 101 inpatients with dermatomyositis in Department of Dermatology, the First Affiliated Hospital of Soochow University from April 2008 to April 2018. These patients were divided into ANA - positive group and ANA-negative group, and differences in myopathy and malignancy risks as well as other clinical features were analyzed between the 2 groups. A 2-year follow-up was undertaken among 92 patients. Chi-square test was used to analyze and compare clinical features between the 2 groups, and a multivariate regression model was used to analyze the relationship of ANA status with amyopathic dermatomyositis and malignancies. Results Among the 101 patients with dermatomyositis, there were 42 males and 59 females, aged 55.13 ± 14.63 years; 14 patients had amyopathic dermatomyositis, 6 patients had hypomyopathic dermatomyositis, and 81 patients had myopathic dermatomyositis; 42 （41.58%） cases were positive for ANA, and 59 （58.41%） were negative for ANA. Compared with the ANA- negative group, the ANA - positive group showed significantly decreased incidence of cervical erythema （33.33% vs. 59.32%, P = 0.010） and shawl sign （14.28% vs. 35.59%, P = 0.017）. Twenty-eight （27.72%） patients with dermatomyositis were complicated by malignancies. Malignancies were found in 5 （11.9%） of ANA-positive patients, and in 23 （38.98%） of ANA - negative patients. Univariate analysis showed that ANA-negative patients with dermatomyositis had a higher risk of malignancies compared with ANA-positive patients with dermatomyositis, with an odds ratio of 7.52 （95% CI: 1.62 - 13.78, P = 0.003）. In the multivariate regression model, the absence of ANA （OR = 4.34, 95% CI: 1.37 - 13.72, P = 0.012） and cervical erythema （OR = 3.27, 95% CI: 1.20 - 8.91, P = 0.020） were associated with high incidence of malignancies, while the absence of ANA was not significantly correlated with the occurrence of amyopathic dermatomyositis （OR = 0.99, 95% CI: 0.32 - 2.99, P = 0.980）. Conclusions ANA-negative adult dermatomyositis patients with cervical erythema had an increased risk of malignancies. Thus, close follow-up and regular tumor screening are necessary in these patients.

Key words: Dermatomyositis, Antibodies, antinuclear, Neoplasms, V-shaped erythema