皮肌炎、多发性肌炎合并心脏损害的危险因素分析
Risk Factors Associated with Cardiac Involvement in Patients with Dermatomyositis/Polymyositis
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摘要: 目的 探讨皮肌炎或多发性肌炎(DM/PM)合并心脏损害(cardiac involvement,CI)的危险因素。 方法 回顾性分析129例DM/PM患者临床资料,采用χ2检验、独立样本t检验作单因素筛选,logistic回归作多因素分析,构建ROC曲线进行诊断试验评价。 结果 59例DM/PM患者合并CI,并发率为45.74%;其中心电图异常41例(69.49%)、超声心动图异常25例(42.37%)、心力衰竭8例(13.56%)、心肌梗死2例(3.39%),病死率13.56%(8/59)。CI者平均年龄较无CI者高(P<0.05),并发肺间质病变的比率高(P<0.05),出现血清抗核抗体(ANA)及抗Jo-1抗体阳性率高(P<0.05)。Logistic回归分析显示肺间质病变(β=1.554)、血清门冬氨酸氨基转移酶/肌酸激酶(AST/CK)比值(β=1.189)、ANA阳性(β=1.172)、年龄(β=0.042)与DM/PM并发CI相关(P<0.05)。ROC曲线分析示AST/CK诊断CI的ROC曲线下面积为0.642(P<0.05),但诊断准确性较低,AST/CK比值0.312可作为判断并发CI的参考临界值。 结论 DM/PM合并CI常呈亚临床表现,心电图和超声检查是诊断心脏损害的主要方法,肺间质病变、AST/CK高比值、ANA阳性及高龄可能是DM/PM合并CI的危险因素。Abstract: Objective To identify risk factors associated with cardiac involvement (CI) in patients with dermatomyositis/polymyositis (DM/PM). Methods Medical records of 129 DM/PM patients were reviewed retrospectively. The risk factors associated with CI in those patients were screened through χ2 tests or independent t tests before a multivariate logistic regression analysis was performed. ROC curves were constructed to determine diagnostic values of the identified risk factors. Results CI occurred in 59 (45.74%) of DM/PM patients, with 41 (69.49%) showing electrocardiographic (ECG) abnormality; 25 (42.37%) showing ultrasonic cardiogram (UCG) abnormality; 8 (13.56%) being diagnosed with heart failure, and 2 (3.39%) being diagnosed with myocardial infarction. Eight (13.56%) of the patients with CI died. CI was more likely to occur in patients with an older age, having interstitial lung disease, antinuclear antibody (ANA) positive, and anti-Jo-1 antibody positive (P<0.05). The logistic regression analysis revealed that interstitial lung disease (β=1.554), aspartic aminotransferase/creatine kinases (AST/CK) ratio (β=1.189), positive ANA (β=1.172) and age (β=0.042) were risk factors associated with CI (P<0.05). Notable areas under ROC curve (0.642) was found for AST/CK in determining CI in DM/PM patients (P<0.05), albeit with low accuracy. A cut-off of AST/CK ratio at 0.312 was identified as a reference point for determining CI in patients with DM/PM. Conclusion Cardiac involvement is the most common complication of DM/PM, although the majority are subclinical. ECG and UCG are common tools for diagnosing cardiac involvement. Interstitial lung disease, AST/CK ratio, positive ANA and age are predictors of CI in DM/PM patients.
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