92例多发性肌炎/皮肌炎患者短期生存预后相关因素分析

摘要/Abstract

摘要： 目的: 探索影响多发性肌炎/皮肌炎(PM/DM)患者短期生存及预后危险因素。方法: 收集2006年7月至2013年7月本院住院治疗101例PM/DM患者临床资料和相关实验室检查, 9例失访, 随访92例患者为研究对象, 分死亡组和非死亡组, 分析影响短期生存和预后危险因素。结果: 92例患者中男29例, 女63例, 其中PM 41例, DM 51例, 死亡15例, 其中PM 4例, DM 11例。死亡组患者年龄(59.1±10.6)岁高于非死亡组(44.3±12.9)岁, 中位数病程[9(3~123)]月明显短于非死亡组[46(4~174)]月, 血清白蛋白(ALB)水平[(31.9±4.3) g/L] 低于非死亡组[(37.4±6.1) g/L], 死亡组患者红细胞沉降率(ESR)[(46.1±32.6) mm/h]高于非死亡组(30.6±24.9) mm/h], C反应蛋白(CRP)水平[(32.5±25.4) mg/L]高于非死亡组[(18.0±11.7) mg/L], 差异有统计学意义(P分别为 0.045 和 0.026)。死亡组间质性肺病(ILD)发生率(11/15, 73.33% vs 29/77, 37.66%)、心脏损害发生率(9/15, 60.00% vs 24/77, 31.17%)及肺部感染发生率(10/15, 66.67% vs 24/77, 31.17%)均高于非死亡组, 差异均有统计学意义。预测PM/DM患者1、5、10年生存率分别为 88.7%、82.3%、59.5%, 多因素COX回归显示年龄[χ² =14.128, P＜0.001, RR为 1.102, 95%CI(1.048~1.160)]、合并ILD[χ²=4.642, P=0.031, RR为 0.284, 95%CI(0.090~0.893)]、低ALB血症[χ²=7.543, P=0.006, RR为 0.890, 95%CI(0.819~0.967)]、心脏损害[χ²=4.980, P=0.026, RR为 0.306, 95%CI(0.108~0.866)]及合并肺部感染[χ²=5.451, P=0.020, RR为 0.277, 95%CI为(0.095~0.140)]均是影响其预后危险因素。结论: PM/DM死亡组患者年龄大、病程短, 血清ALB水平偏低, ILD、心脏损害及肺部感染发生率高, 其中年龄、低ALB血症、合并ILD、心脏损害及肺部感染是影响PM/DM患者短期预后的重要危险因素。

关键词: 多发性肌炎, 皮肌炎, 预后, 危险因素

Abstract: AIM : To investigate the risk factors on survival and prognosis of polymyositis/dermatomyositis(PM/DM).METHODS: The clinical and laboratory data of 101 PM/DM patients from July 2006 to July 2013 in Yijishan Hospital were collected, 9 cases were lost. The 92 patients were divided into a death group and a non-death group. The clinical feature and prognosis were analyzed retrospectively. The clinical and laboratory data were analyzed by using the SPSS 16.0 software. Survival analysis and COX regression were performed to analyze the prognosis and related risk factors for 92 patients followed up.RESULTS:The 92 patients with PM/DM comprised 29 males and 63 females. The idiopathic DM was 51 cases, PM was 41cases. During the follow-up period, 15 patients died, 4 patients with PM, 11 patients with DM. Compared with the non-death group, the age in the death group was markedly older [ (59.1±10.6) years vs (44.3±12.9) years], the median duration [9(3-123) months vs 46(4-174)months, χ² =-3.251, P=0.001] was significantly shorter. The serum levels of ALB [(31.9±4.3) g/L vs (37.4±6.1) g/L, t=2.712, P=0.008], ESR [(46.1±32.6) mm/h vs (30.61±24.9) mm/h, t=2.031, P=0.045] and the serum levels of CRP [(32.5±25.4) mg/L vs (18.0±11.7) mg/L, t=2.263, P=0.026] were statistically different between the two groups. The incidence of ILD [11/15 vs 29/77, χ²=6.56, P=0.010], heart impairment (9/15 vs 24/77, χ²=4.53, P=0.033) and lung infection(10/15 vs 24/77, χ²=5.35, P=0.021)were significantly higher in the death group. Survival estimates in the whole group at 1, 5 and 10 years was 88.7%, 82.3%, 59.5%, respectively.The unfavourable prognostic factors were increased age(χ²=14.128, P<0.001, RR=1.102, 95%CI 1.048-1.160), ILD(χ²=4.642, P=0.031, RR=0.284, 95%CI 0.090-0.893), low ALB level(χ²=7.543, P=0.006, RR=0.890, 95%CI 0.819-0.967), heart impairment(χ²=4.980, P=0.026, RR=0.306, 95%CI 0.108-0.866) and lung infection (χ²=5.451 P=0.020, RR=0.277, 95%CI 0.095-0.140) by multivariate COX regression analysis.CONCLUSION: Patients in the death group showed older age, shorter duration, lower ALB level and higher incidence of ILD , heart impairment and lung infection than in the non-death group. Increased age, low ALB level and complicated ILD, heart impairment, lung infection were poor prognosis factors of PM/DM patients.

Key words: polymyositis, dermatomyositis, survival anlysis, risk factor

中图分类号:

R593.26

盛君, 陆进明, 宣丹, 强孚勇, 徐亮. 92例多发性肌炎/皮肌炎患者短期生存预后相关因素分析[J]. 中国临床药理学与治疗学, 2014, 19(6): 674-679.

SHENG Jun, LU Jin-ming, XUAN Dan, QIANG Fu-yong, XU Liang. Short-term survival analysis of predictive factors associated with mortality in 92 patients with polymyositis and dermatomyositis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(6): 674-679.

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