Risk Factors And Survival Analysis Of Dermatomyositis Patients With Interstitial Lung Disease

BackgroundDermatomyositis(DM)is a group of chronic autoimmune diseases that can affect multiple systems.Apart from the skin,muscles,and joints,lung is also an organ that it often invades.Interstitial lung disease(ILD)is a kind of common complication in patients associated with DM and can significantly affect their prognosis.However,the disease development and prognosis of DM-ILD patients have obvious heterogeneity.Therefore,it is necessary to find the risk factors of ILD and the survival factors with the purpose of providing help for clinical work.Pulmonary imaging classification is closely related to the prognosis of ILD,and its value of clinical guidance is being paid more and more attention.At present,there are few studies on the influence of lung imaging classification on the prognosis of myositis-related ILD.Objection1.To find out the independent risk factors of ILD in DM patients by comparing the differences in clinical characteristics and laboratory tests between DM-N-ILD and DM-ILD patients.2.To explore the predictive factors of survival in DM-ILD patients.3.To compare the changes of different pulmonary imaging types before and after treatment and their differences in long-term prognosis,and find the types with poor prognosis.So that we can find the poor prognosis classification and provide help for subsequent clinical diagnosis and treatment.Methods1.Data collection:A total of 249 DM patients who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2014 to March 2019 and met the Bohan and Peter criteria were selected.General data,clinical data,laboratory examinations and HRCT images were collected.The DM patients were divided into two groups based on the absence or presence of ILD,DM-N-ILD group(n=151)and DM-ILD group(n=98).Follow-up was carried out to record the survival time and the related causes of death.The imaging classification of pulmonary HRCT in patients with DM-ILD was carried out by an experienced professional radiologist.2.Risk factors of DM-ILD:Firstly,univariate analysis was made on the general data,clinical symptoms,laboratory examination and other clinical indexes of patients in DM-ILD group and DM-N-ILD group.And then the variables with P<0.1 in the results were taken into the multivariate logistic regression analysis model.Finally,the two-sided P<0.05 means statistical significance.3.Survival analysis of DM-ILD:The survival rate was analyzed by Kaplan-Meier method,the difference of survival rate between the two groups was compared by Log-rank t test.4.The influence of lung imaging classification on prognosis:The changes of pulmonary imaging classification and the long-term prognosis of different types at the beginning of treatment and 12 months after treatment were compared.Results1.A total of 249 DM patients(including 98 DM-ILD patients)were enrolled,the age of onset was 49.37±13.20 years,and the course of disease was 5.67±8.67 months,the female sex accounted for 75.49%.Logistic multivariate analysis suggested that positive anti-Ro52 antibody,arthritis,and mechanic hands were independent risk factors for ILD.2.The proportion for non-specific interstitial pneumonia(NSIP)was came to 74.49%.NSIP was the most common pulmonary imaging type of DM-ILD with better prognosis,while acute interstitial pneumonia(AIP)had the worst prognosis.3.The 1-year,3-year,and 5-year survival rates of DM-ILD patients were 81.0%,72.0%,and 68.3%,respectively,compared to 96.0%,84.7%,74.7%in DM-N-ILD patients(P<0.05).4.AIP(HR=6.422,P=0.023),dyspnea(HR=29.89,P<0.001),lung infection(HR=4.326,P=0.008)were independent risk factors for survival in DM-ILD patients.Conclusion1.Arthritis,mechanic hands,and anti-Ro52 antibody positive are closely related to the risk of DM-ILD.It is suggested that the above risk factors should be identified and diagnosed as soon as possible.2.The survival rate of DM patients with ILD is low and the prognosis is poor.3.Pulmonary infection,dyspnea and AIP are obviously related to poor prognosis of ILD.DM-ILD patients with the above symptoms needed to be actively treated,so as to improve their survival rate.