预后营养指数(PNI)和多发性肌炎/皮肌炎合并间质性肺疾病的相关性分析
Correlation between Prognostic Nutritional Index (PNI) and Interstitial Lung Disease in Patients with Polymysitis/Dermatomyositis
摘要: 目的：探讨预后营养指数(PNI)在多发性肌炎/皮肌炎合并间质性肺疾病(PM/DM-ILD)的相关性以及PNI在PM/DM-ILD中的诊断价值。方法：回顾性分析270例PM/DM患者的临床资料，根据肺部影像结果分为多发性肌炎/皮肌炎合并间质性肺疾病组(PM/DM-ILD组，n = 147)及未合并间质性肺疾病组(对照组，n = 123)，比较PM/DM-ILD组与对照组的PNI；采用Spearman秩相关分析及Pearson相关分析探讨PNI与其他实验室指标的相关性；采用二元logistics回归分析PM/DM合并ILD的危险因素；采用ROC曲线分析PNI对PM/DM合并ILD的诊断价值。结果：PM/DM-ILD组的PNI、白蛋白(ALB)、补体C3 (C3)、淋巴细胞计数(LY)、白细胞计数(WBC)、血小板计数(PLT)、单核细胞数(MO)及血红蛋白(Hb)水平均低于对照组(P < 0.05)；PM/DM-ILD组IgA水平、抗Ro-52抗体阳性比例及抗MAD5抗体阳性比例高于对照组(P < 0.05)；两组间性别比、年龄、C反应蛋白(CRP)、血沉(ESR)、IgG、IgM、IgE、抗Jo-1抗体阳性比例、抗EJ抗体阳性比例及抗PL-7抗体阳性比例均无统计学差异(P > 0.05)。相关分析结果显示，PM/DM-ILD患者PNI与LY、Hb、ALB、补体C3、PLT均呈正相关(rs = 0.638、0.338、0.926、0.369、0.348，P均<0.05)，PNI与抗MDA5抗体呈负相关(rs = −0.460, P < 0.05)。二元logistics回归分析结果显示PNI水平的降低是PM/DM合并ILD的独立危险因素。PNI、ALB、LY诊断PM/DM合并ILD的ROC AUC值分别为0.838、0.824、0.718。结论：PM/DM-ILD患者PNI水平显著降低，PNI对于评估PM/DM合并ILD具有一定的临床诊断价值。
Abstract: Objective: To explore the relevance of prognostic nutritional index (PNI) in polymyositis/derma- tomyositis combined with interstitial lung disease (PM/DM-ILD) and the diagnostic value of PNI in PM/DM-ILD. Methods: Clinical data of 270 patients with PM/DM were collected. According to the presence or absence of imaging findings of ILD, they were divided into PM/DM-ILD group (n = 147) and control group (n = 123). PNI between the two groups was compared; Spearman rank correla-tion analysis and Pearson correlation analysis were used to study the correlation between PNI and other laboratory indicators; Binary logistic regression was used to analyze the risk factors of ILD in PM/DM; ROC curve was used to analyze the diagnostic value of PNI for ILD in PM/DM. Results: The levels of PNI, ALB, C3, LY, WBC, PLT, MO and Hb in PM/DM-ILD were lower than those in the control (P < 0.05). The levels of IgA, the positive proportion of antiRo-52 and anti-MDA5 in PM/DM-ILD were higher than those in the Control (P < 0.05). Gender ratio, age, CRP, ESR, IgG, IgM, IgE, and the posi-tive proportion of anti-Jo-1, anti-EJ and anti-PL-7 between the two groups were not statistically dif-ferent (P > 0.05). The results of correlation analysis showed that PNI was positively correlated with LY, Hb, ALB and C3, PLT in patients with ILD (rs = 0.638, 0.338, 0.926, 0.369, 0.348, P < 0.05) and PNI was negatively correlated with anti-MDA5 (rs = −0.460, P < 0.05). Binary logistic regression analysis showed that the decrease of PNI level was an independent risk factor for ILD in PM/DM. The ROC AUC values of ILD in PM/DM diagnosed by PNI, ALB and LY were 0.838, 0.824 and 0.718 respectively. Conclusion: The level of PNI in PM/DM-ILD patients is significantly decreased. PNI has certain clinical diagnostic value in the evaluation of PM/DM with ILD.
文章引用：颜苏艳, 李美琪, 刘保成, 杨清锐, 麻贞贞. 预后营养指数(PNI)和多发性肌炎/皮肌炎合并间质性肺疾病的相关性分析[J]. 临床医学进展, 2023, 13(8): 12421-12429. https://doi.org/10.12677/ACM.2023.1381741

参考文献

[1] Lundberg, I.E., Fujimoto, M., Vencovsky, J., et al. (2021) Idiopathic Inflammatory Myopathies. Nature Reviews Disease Primers, 7, Article No. 86. [Google Scholar] [CrossRef] [PubMed]
[2] Lega, J.-C., Reynaud, Q., Belot, A., et al. (2015) Idiopathic Inflammatory Myopathies and the Lung. European Respiratory Review, 24, 216-238. [Google Scholar] [CrossRef] [PubMed]
[3] Mathai, S.C. and Danoff, S.K. (2016) Management of Interstitial Lung Disease Associated with Connective Tissue Disease. BMJ, 352, h6819. [Google Scholar] [CrossRef] [PubMed]
[4] Sun, K.-Y., Fan, Y., Wang, Y.-X., et al. (2021) Prevalence of Interstitial Lung Disease in Polymyositis and Dermatomyositis: A Meta-Analysis from 2000 to 2020. Seminars in Arthritis and Rheumatism, 51, 175-191. [Google Scholar] [CrossRef] [PubMed]
[5] Yang, X., Hao, Y., Zhang, X., et al. (2020) Mortality of Chi-nese Patients with Polymyositis and Dermatomyositis. Clinical Rheumatology, 39, 1569-1579. [Google Scholar] [CrossRef] [PubMed]
[6] Yu, K.-H., Wu, Y.-J.J., Kuo, C.-F., et al. (2011) Survival Analysis of Patients with Dermatomyositis and Polymyositis: Analysis of 192 Chinese Cases. Clinical Rheumatology, 30, 1595-1601. [Google Scholar] [CrossRef] [PubMed]
[7] Yoo, H., Hino, T., Hwang, J., et al. (2022) Connec-tive Tissue Disease-Related Interstitial Lung Disease (CTD-ILD) and Interstitial Lung Abnormality (ILA): Evolving Concept of CT Findings, Pathology and Management. European Journal of Radiology Open, 9, Article ID: 100419. [Google Scholar] [CrossRef] [PubMed]
[8] Verschakelen, J.A. (2010) The Role of High-Resolution Computed Tomography in the Work-Up of Interstitial Lung Disease. Current Opinion in Pulmonary Medicine, 16, 503-510. [Google Scholar] [CrossRef] 
[9] Onodera, T., Goseki, N. and Kosaki, G. (1984) Prognostic Nutritional Index in Gastrointestinal Surgery of Malnourished Cancer Patients. Nihon Geka Gakkai Zasshi, 85, 1001-1005.
[10] Luan, C., Wang, F., Wei, N., et al. (2020) Prognostic Nutritional Index and the Prognosis of Diffuse Large b-Cell Lymphoma: A Meta-Analysis. Cancer Cell International, 20, Article No. 455. [Google Scholar] [CrossRef] [PubMed]
[11] Wang, Z., Wang, Y., Zhang, X., et al. (2018) Pretreatment Prognostic Nutritional Index as a Prognostic Factor in Lung Cancer: Review and Meta-Analysis. Clinica Chimica Acta, 486, 303-310. [Google Scholar] [CrossRef] [PubMed]
[12] Wang, Z., Zhao, L. and He, S. (2021) Prognostic Nu-tritional Index and the Risk of Mortality in Patients with Hypertrophic Cardiomyopathy. International Journal of Cardi-ology, 331, 152-157. [Google Scholar] [CrossRef] [PubMed]
[13] Song, A., Eo, W. and Lee, S. (2015) Comparison of Selected In-flammation-Based Prognostic Markers in Relapsed or Refractory Metastatic Colorectal Cancer Patients. World Journal of Gastroenterology, 21, 12410-12420. [Google Scholar] [CrossRef] [PubMed]
[14] 吴军来, 严丽芳, 张莉, 等. 预后营养指数与原发性干燥综合症患者疾病活动度的相关性研究[J]. 中国实用内科杂志, 2022, 42(3): 229-232.
[15] Correa-Rodríguez, M., Po-covi-Gerardino, G., Callejas-Rubio, J.-L., et al. (2019) The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus. Nutrients, 11, Article No. 638. [Google Scholar] [CrossRef] [PubMed]
[16] Wells, A.U. and Denton, C.P. (2014) Interstitial Lung Disease in Con-nective Tissue Disease—Mechanisms and Management. Nature Reviews Rheumatology, 10, 728-739. [Google Scholar] [CrossRef] [PubMed]
[17] Fathi, M. and Lundberg, I.E. (2005) Interstitial Lung Disease in Polymyositis and Dermatomyositis. Current Opinion in Rheumatology, 17, 701-706. [Google Scholar] [CrossRef] [PubMed]
[18] Fischer, A. and Du Bois, R. (2012) Interstitial Lung Disease in Connective Tissue Disorders. The Lancet, 380, 689-698. [Google Scholar] [CrossRef] 
[19] Li, L., Wang, H., Wang, Q., et al. (2019) Myositis-Specific Autoantibodies in Dermatomyositis/Polymyositis with Interstitial Lung Disease. Journal of the Neurological Sciences, 397, 123-128. [Google Scholar] [CrossRef] [PubMed]
[20] Vojinovic, T., Cavazzana, I., Ceruti, P., et al. (2021) Predictive Features and Clinical Presentation of Interstitial Lung Disease in Inflammatory Myositis. Clinical Reviews in Allergy & Immunology, 60, 87-94. [Google Scholar] [CrossRef] [PubMed]
[21] Kurtzman, D.J.B. and Vleugels, R.A. (2018) Anti-Melanoma Differentiation-Associated Gene 5 (MDA5) Dermatomyositis: A Concise Review with an Emphasis on Distinctive Clin-ical Features. Journal of the American Academy of Dermatology, 78, 776-785. [Google Scholar] [CrossRef] [PubMed]
[22] Nombel, A., Fabien, N. and Coutant, F. (2021) Dermatomyositis with Anti-MDA5 Antibodies: Bioclinical Features, Pathogenesis and Emerging Therapies. Frontiers in Immunology, 12, Article ID: 773352. [Google Scholar] [CrossRef] [PubMed]
[23] Xu, A., Ye, Y., Fu, Q., et al. (2021) Prognostic Values of An-ti-Ro52 Antibodies in Anti-MDA5-Positive Clinically Amyopathic Dermatomyositis Associated with Interstitial Lung Disease. Rheumatology (Oxford, England), 60, 3343-3351. [Google Scholar] [CrossRef] [PubMed]
[24] Xing, X., Li, A. and Li, C. (2020) Anti-Ro52 Antibody Is an Independent Risk Factor for Interstitial Lung Disease in Dermatomyositis. Respiratory Medicine, 172, Article ID: 106134. [Google Scholar] [CrossRef] [PubMed]
[25] Wright, H.L., Moots, R.J., Bucknall, R.C. and Edwards, S.W. (2010) Neutrophil Function in Inflammation and Inflammatory Diseases. Rheumatology (Oxford), 49, 1618-1631. [Google Scholar] [CrossRef] [PubMed]
[26] Mueller, S.N., Gebhardt, T., Carbone, F.R. and Heath, W.R. (2013) Memory T Cell Subsets, Migration Patterns, and Tissue Residence. Annual Review of Immunology, 31, 137-161. [Google Scholar] [CrossRef] [PubMed]
[27] Gebhardt, T., Whitney, P.G., Zaid, A., et al. (2011) Different Patterns of Peripheral Migration by Memory CD4+ and CD8+ T Cells. Nature, 477, 216-219. [Google Scholar] [CrossRef] [PubMed]
[28] Huang, W., Ren, F., Luo, L., et al. (2020) The Characteristics of Lym-phocytes in Patients Positive for Anti-MDA5 Antibodies in Interstitial Lung Disease. Rheumatology (Oxford), 59, 3886-3891. [Google Scholar] [CrossRef] [PubMed]
[29] Chen, F., Wang, D., Shu, X., Nakashima, R. and Wang, G. (2012) Anti-MDA5 Antibody Is Associated with A/SIP and Decreased T Cells in Peripheral Blood and Predicts Poor Prognosis of ILD in Chinese Patients with Dermatomyositis. Rheumatology International, 32, 3909-3915. [Google Scholar] [CrossRef] [PubMed]
[30] Xu, Y., Yang, C.S., Li, Y.J., et al. (2016) Predictive Factors of Rapidly Progressive-Interstitial Lung Disease in Patients with Clinically Amyopathic Dermatomyositis. Clinical Rheu-matology, 35, 113-116. [Google Scholar] [CrossRef] [PubMed]
[31] Lv, X., Jin, Y., Zhang, D., et al. (2022) Low Circulating Mono-cytes Is in Parallel with Lymphopenia Which Predicts Poor Outcome in Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis-Associated Interstitial Lung Disease. Frontiers in Medicine (Lausanne), 8, Article ID: 808875. [Google Scholar] [CrossRef] [PubMed]
[32] Don, B.R. and Kaysen, G. (2004) Serum Albumin: Relationship to Inflammation and Nutrition. Seminars in Dialysis, 17, 432-437. [Google Scholar] [CrossRef] [PubMed]
[33] Zisman, D.A., Kawut, S.M., Lederer, D.J., et al. (2009) Serum Albumin Concentration and Waiting List Mortality in Idiopathic Interstitial Pneumonia. Chest, 135, 929-935. [Google Scholar] [CrossRef] [PubMed]
[34] Ahn, S.S., Jung, S.M., Song, J.J., et al. (2018) Prognostic Nutritional Index Is Correlated with Disease Activity in Patients with Systemic Lupus Erythematosus. Lupus, 27, 1697-1705. [Google Scholar] [CrossRef] [PubMed]
[35] Isoda, K., Tsuji, S., Harada, Y., et al. (2022) Potential of the Prognostic Nutritional Index to Determine the Risk Factor for Severe Infection in Elderly Patients with Rheumatoid Ar-thritis. Modern Rheumatology, 2022, roac001. [Google Scholar] [CrossRef] [PubMed]
[36] Kim, J.W., Jung, J.Y., Suh, C.H., et al. (2021) Systemic Im-mune-Inflammation Index Combined with Ferritin Can Serve as a Reliable Assessment Score for Adult-Onset Still’s Disease. Clinical Rheumatology, 40, 661-668. [Google Scholar] [CrossRef] [PubMed]

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