Clinical Analysis Of CT Quantification Of Pulmonary Interstitial Lesions And Autoantibodies Of In Idiopathic Inflammatory Myopathy

Objective:The clinical heterogeneity of idiopathic inflammatory myopathy(IIM)is large.This study aims to analyze the correlation between myositis antibody profile,including myositis-specific antibodies(MSAs)and myositis-associated antibodies(MAAs),and clinical data such as pulmonary interstitial disease(ILD)in patients,preliminarily explore the feasibility of using CT imaging quantitative calculation method to evaluate the severity of IIM patients with ILD,to provides a new clinical idea for the diagnosis,differential diagnosis,prediction of complications,treatment and prognosis of IIM and its ILD.Methods:Clinical data of 133 patients with IIM who were hospitalized in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 were collected and analyzed,including general information,clinical manifestations,laboratory index and imaging examinations,etc.,collecting patient serum to measure MSAs and MAAs using immunoprecipitation,analyze the correlation between MSAs,MAAs,ILD,and laboratory indicators,and for the first time,the Dr.Wise Lung Analyzer chest CT assisted diagnosis system was used to quantitatively calculate the severity of ILD,To explore the correlation between ILD and clinical characteristics.All data were statistically analyzed using SPSS21.0,and P<0.05 was defined as statistically significant difference.Results:1.Among the 133 IIM patients,the positive rate of MSAs was 86.92%,the most common types of MSAs were anti-MDA5 antibody,anti-SRP antibody,and anti-Jo-1 antibody,the positive rates were 25.47%,14.15%,and 11.32%,respectively.The positive rate of anti-ARS antibody was 26.17%.Patients with interstitial lung disease(ILD)accounted for 68.42%(91/133),muscle weakness accounted for 59.40%(79/133),and arthralgia accounted for 40.60%(54/133),characteristic rash accounted for 39.10%(52/133),and the most common characteristic rash was positive rash,accounting for 29.32%(39/133).Male patients are more likely to have V-shaped shawl sign than female patients(P=0.024).2.The lung interstitial lesions quantitatively calculated by Dr.Wise Lung Analyzer chest CT auxiliary diagnostic system include ground glass shadow,consolidation shadow,grid shadow and honeycomb changes.3.Analyzing the ILD of different myositis antibodies found:Compared with the anti-MDA5 antibody-positive group and the anti-MDA5 antibody-negative group,the total lung lesion volume,bilateral lung lesion volume,and lung involvement of both lungs calculated by CT quantitatively were higher than those of the antibody-negative group,Among them,the left lung lesion volume and the lung segment involved in the left lung were significantly different(P<0.05).However,there was no significant difference in CT quantitative indexes between the positive and negative anti-ARS antibody groups.Comparing the anti-MDA5 antibody positive group,the anti-ARS antibody positive and the double antibody negative group,the three groups have statistically significant differences in the total lung lesion volume(P=0.015)and the lung segment involved in the left lung(P=0.019),two of them Compare,The lung segment involved in the left lung of the anti-MDA5 antibody positive group was significantly higher than that of the MSN group(P<0.05),and the total lung volume of the anti-ARS antibody positive group was significantly higher than that of the MSN group(P<0.05).There were significant differences in total lung lesion volume,left lung lesion volume,right lung lesion volume,lung segment involved in the left lung and lung segment involved in the right lung among the dermatomyositis group,polymyositis group and anti-synthase antibody syndrome group(P<0.05).Pairwise comparison showed that the above indexes of anti-synthetase antibody syndrome were significantly higher than those of polymyositis group,and the average CT value of polymyositis group was higher than that of dermatomyositis group(P<0.05).4.There were significant differences in anti-MDA5 antibody(P<0.001),anti-NXP2 antibody(P=0.019),anti-SRP antibody(P=0.013),anti-EJ antibody(P=0.020)and anti-SSA/RO52 antibody(P=0.004)between the patients with pulmonary interstitial disease and those without pulmonary interstitial disease.2.Logistic regression analysis showed that anti-MDA5 antibody[OR=10.16,95%CI(2.73,37.776),P=0.01]and anti-RO52 antibody[OR=2.90,95%CI(1.16,7.27),P=0.023]were independent risk factors of ILD,respectively.5.The incidence of lung interstitial lesions,sun rash,Gottron rash,V-shaped shawl sign,skin ulcers,arthralgia and the levels of C4,IgA,and ESR in anti-MDA antibody-positive patients were higher than those of anti-MDA5 antibody-negative patients(P<0.05),The incidence of dysphagia,dyspnea,pulmonary hypertension and the levels of WBC,LDH,CK,CKMB and NK cell in anti-MDA antibody-positive patients were lower than those of anti-MDA5 antibody-negative patients(P<0.05).6.The incidence of pulmonary hypertension and the levels of WBC,IgM and CD4+lymphocytes in anti-JO-1 antibody positive group were higher than those in anti-JO-1 antibody negative group(P<0.05),The incidence of aphrodisiac,V-shaped shawl sign and the levels of C4 in anti-JO-1 antibody positive patients were lower than those in anti-JO-1 antibody negative patients(P<0.05).7.The levels of ALT,AST,LDH,CKMB,T lymphocytes,B lymphocytes and CD4+ lymphocytes in anti-SRP antibody positive group were higher than those in anti-SRP antibody negative group(P<0.05),the incidence of pulmonary interstitial disease,V-shaped shawl sign and the levels of Scr in anti-SRP positive patients were lower than those in anti-SRP negative patients(P<0.05).8.There was a statistically significant difference between the anti-MDA5 positive group and the anti-ARS antibody positive group in sun rash,V-shaped shawl sign,Gottron rash,dyspnea,pulmonary hypertension,CK,C4,,IgG and NK cell(P<0.05).There was a statistically significant difference between the anti-MDA5 positive group and the MSN group in ILD,sun rash,V-shaped shawl sign,Gottron sign,arthralgia,joint swelling,dysphagia,WBC,GLB,AST,LDH,CK,CKMB,C4,IgG,IgA,IgM.,and ESR(P<0.05).There was a statistically significant difference between the anti-ARS antibody positive group and the MSN group in ILD,sun rash,and type V shawl sign,ALB,AST,Scr,IgG,IgM,and ESR(P<0.05).Conclusions:1.Anti-MDA5 antibodies and anti-ARS antibodies are the most common subtypes of MS As;2.It was found that anti-MDA5 antibody and anti-ARS antibody were related to the lesion range and degree of ILD by calculating ILD with chest CT-assisted diagnostic system of Dr.Wise Lung Analyzer,anti-synthase antibody syndrome ILD is more serious than dermatomyositis and polymyositis.3.Anti-MDA5 antibody and anti-RO52 antibody are independent risk factors of IIM with ILD.4.Different MSAs subtypes are related to specific clinical characteristics and laboratory tests,which can be used to classify different patients,guide treatment and judge prognosis.