A Clinical Research Of Clinical Characteristics And Risk Factors Of Adult Dermatomyositis/Polymyositis

BackgroundDermatomyositis(DM)and polymyositis(PM),which often involve in striated muscle,belong to idiopathic inflammatory myopathy.Pathological changes of DM/PM belong to chronic and non suppurative lesions.The most common clinical factors that lead to poor prognosis in DM/PM are infection,interstitial pneumonia and tumor.It is found that although DM and PM belong to IIM,they have different clinical characteristics,histopathological characteristics,response to treatment and prognosis.Past clinical studies usually combine DM and PM.A systematic contrastive study of DM and PM is rare.The sample size of related clinical studies is usually not much.Studies usually do not distinguish between juvenile DM/PM patients and adult DM/PM patients.All these factors will cause deviations in the study of clinical characteristics and risk factors of DM/PM.This study distinguishes between DM and PM.Through the analysis and comparison of the clinical characteristics of adult DM and PM and the independent risk factors of DM and PM combined with infection,ILD and tumor,we can deepen the understanding of DM and PM,which helps the clinical diagnosis and prognosis.Objective1.By retrospective analysis of 339 adult DM/PM cases,the clinical characteristics of adult DM and PM were compared.2.Define the independent risk factors of adult DM and PM combined with ILD,infection or tumor respectively.Research objects and methods230 adult DM patients and 109 adult PM patients in accordance with Bohan and Peter’s diagnostic criteria for DM/PM in 1975 or diagnostic criteria for DM and PM in IIM classification diagnostic criteria developed by the European Center for neuromuscular disease(ENMC)in 2004 were selected as the object of study.They were collected from Nanfang Hospital from June 2008 to June 2017.To group adult DIM/PM patients respectively into case group and control group according to gender,the expression of ANA and anti-Jo-1 antibody,ILD,infection or cancer.To analyze the difference of age,course of disease,clinical manifestations,laboratory examination,imaging findings,therapy and prognosis between groups.To explore independent risk factors of adult DM/PM cases combined with ILD,infection or tumor.The data was analysed with SPSS 20.0 statistical software.The measurement data was assessed by t-test and the chi-square test was used for enumeration data.The difference was statistically significant when P<0.05.To analyze independent risk factors of adult DM/PM combined with ILD,infection or tumor,the suspected risk factors were analyzed by single factor analysis,and multiple factor Logistic regression analysis was carried out for the risk factors of statistical difference in the results.ResultsChapter1 the clinical characteristics of adult DM/PM 1.1 sexThe incidence of heliotrope rash,shawl sign,dysphagia,the rise of DBIL,IBIL,TBIL and UREA,the reduction of HGB in male adult DM patients is higher than that in female adult DM patients while the incidence of the reduction of HGB in male adult PM patients is higher than that in female adult PM patients and the difference has statistical sense(P<0.05).The incidence of the reduction of PLT,positive ANA and positive CENPB in female adult DM patients is higher than that in male adult DM patients while the incidence of positive SSA,the rise of IgG and IgM in female adult PM patients is higher than that in male adult PM patients and the difference has statistical sense(P<0.05).1.2 Whether ANA is positiveThe incidence of shawl sign,the rise of CK-MB and IgA,the reduction of C3 in positive ANA adult DM patients is higher than that in negative ANA adult DM patients while the incidence of the reduction of ALB,the rise of Cys-C,BNP,troponin in positive ANA adult PM patients is higher than that in negative ANA adult PM patients and the difference has statistical sense(P<0.05).1.3 Whether anti-Jo-1 antibody is positiveThe incidence of Raynaud phenomenon,the rise of WBC,NEU,NEU%,MYO and the extension of PT in positive anti-Jo-1 antibody adult DM patients is higher than that in negative anti-Jo-1 antibody adult DM patients while the incidence of the rise of CRP,the reduction of HDL,T3 and FT3 in positive anti-Jo-1 antibody adult PM patients is higher than that in negative anti-Jo-1 antibody adult PM patients and the difference has statistical sense(P<0.05).Chapter2 independent risk factors of adult DM/PM complicated with ILD 2.1 adult DMAdult DM patients who are not combined with ILD are prone to heliotrope rash while patients with ILD are prone to Gottron’s papules or Gottron’s sign.Age over 60 years,positive anti-Jo-1 antibody,positive anti-Ro-52 antibody,ALB<30g/L,muscle strength is less than or equal to 4 grade,heliotrope rash,Gottron’s papules or Gottron’s sign,arthralgia are related to adult DM patients complicated with ILD and the difference has statistical sense(P<0.05).Multiple factors Logistic regression analysis showed that the positive anti-Jo-1 antibody(OR:4.521,95%CI:1.375-14.866,P=0.013)and positive anti-Ro-52 antibody(OR:7.297,95%CI:3.410-15.615,P=0.000),muscle strength is less than or equal to 4 grade(OR:2.344,95%CI:1.107-4.963,P=0.026),Gottron’s papules or Gottron’s sign(OR:2.617,95%CI:1.230-5.568,P=0.012)are independent risk factors for adult DM patients complicated with ILD.2.2 adult PMPositive anti-Jo-1 antibody,positive anti-Ro-52 antibody,positive ANA,ALB<30g/L are associated with adult PM patients complicated with ILD and the difference has statistical sense(P<0.05).Multiple factors Logistic regression analysis showed that positive anti-Jo-1 antibody(OR:5.945,95%CI:1.719-17.660,P=0.004)and positive anti-Ro-52 antibody(OR:3.150,95%CI:1.015-9.775,P=0.047)are independent risk factors for adult PM patients complicated with ILD.Chapter 3 independent risk factors of adult DM/PM complicated with infection3.1 adult DMALB<30g/L,ILD,steroid pulse therapy or high-dose steroid pulse therapy,use of immunosuppressive agents,muscle strength is less than or equal to 4 grade are related to adult DM patients complicated with infection and the difference has statistical sense(P<0.05).Multiple factors Logistic regression analysis showed that ALB<30g/L(OR:2.964,95%CI:1.352-6.500,P=0.007)and ILD(OR:3.698,95%CI:1.645-8.315,P=0.002)are independent risk factors for adult DM patients complicated with infection.3.2 adult PMALB<30g/L,ILD,use of immunosuppressive agents,the reduction of C3 are associated with adult PM patients complicated with infection and the difference has statistical sense(P<0.05).Multiple factors Logistic regression analysis showed that ALB<30g/L(OR:8.260,95%CI:1.980-34.458,P=0.004),ILD(OR:3.853,95%CI:1.162-12.771,P=0.027),the reduction of C3(OR:7.047,95%CI:2.028-24.494,P=0.002)are independent risk factors for adult PM patients complicated with infection.Chapter 4 independent risk factors of adult DM/PM complicated with tumorMale,age over 40 years old,ILD,dysphagia,the rise of ESR,poikiloderma,shawl sign and positive anti-Ro-52 antibody are associated with adult DM patients complicated with tumor and the difference has statistical sense(P<0.05).Multiple factors Logistic regression analysis showed that age over 40 years old(OR:4.965,95%CI:1.168-21.110,P=0.030),dysphagia(OR:4.362,95%CI:1.506-12.629,P=0.007)and poikiloderma(oR:4.923,95%CI:1.315-18.425,P=0.018)are independent risk factors of in DM adult patients complicated with tumor.Adult DM patients with ILD(OR:0.073,95%CI:0.014-0.365,P=0.001)are rarely associated with tumor.Conclusions1.Adult DM is more easily associated with tumor than adult PM.The most common tumor of adult DM is nasopharyngeal carcinoma.2.Different characteristic rashes in adult DM patients exist difference.Adult DM patients who are not combined with ILD are prone to heliotrope rash while patients with ILD are prone to Gottron’s papules or Gottron’s sign.3.Positive anti-Jo-1 antibody,positive anti-Ro-52 antibody,muscle strength less than or equal to 4,Gottron’s papules or Gottron’s sign are independent risk factors for adult DM patients complicated with ILD.Positive anti-Jo-1 antibody and positive anti-Ro-52 antibody are independent risk factors for ILD in adult PM patients complicated with ILD.4.ALB<30g/L and ILD are independent risk factors for adult DM patients combined infection.ALB<30g/L,ILD and the reduction of C3 are independent risk factors for adult PM patients combined infection.5.Age over 40 years old,dysphagia and poikiloderma are independent risk factors for adult DM patients complicated with tumor.Adult DM patients with ILD are rarely associated with tumor.