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目的观察影响多发性肌炎(polymyositis,PM)和皮肌炎(dermatomyositis,DM)患者预后的相关因素,并探讨抗Jo1抗体在判断预后中的价值。方法对52例PM(27例)和DM(25例)患者进行1～27年随访,并对所有患者进行抗Jo1抗体测定,临床肌力评定应用4级功能障碍评级法,统计学处理应用科克斯比例危险模式、四格表确切概率法及χ2分析影响PM和DM患者预后相关因素。结果52例患者病死率21.2%,1年生存率86.2%,3年生存率81.4%,5年生存率78.4%,9年生存率74.6%,未发现与生存时间密切相关的因素。伴有恶性肿瘤(P=0.003)、间质性肺炎(P=0.006),吞咽困难(P=0.004)患者病死率高于不伴上述疾病患者,痊愈和基本治愈患者占生存患者的60.7%。发病时肌肉功能情况与预后无关。52例PM和DM患者抗Jo1抗体阳性9例(17.3%),其中PM阳性者6例(22.2%),DM阳性者3例(12.0%),抗Jo1抗体阳性患者66.7%伴间质性肺炎,33.3%伴吞咽困难。结论PM和DM患者长期预后较好,存活者中大部分患者可基本痊愈,伴有恶性肿瘤、间质性肺炎、吞咽困难患者病死率高。抗Jo1抗体阳性患者易伴间质性肺炎和吞咽困难。
Objective To investigate the prognostic factors of patients with polymyositis (PM) and dermatomyositis (DM) and explore the value of anti-Jo1 antibody in predicting the prognosis. Methods Fifty-two patients with PM (27 cases) and DM (25 cases) were followed up for 1 to 27 years. Anti-Jo1 antibody was determined in all patients. Grade 4 dysfunction rating was applied to clinical muscular strength assessment. Kesi ratio dangerous model, the exact table of four tables and χ2 analysis of the impact of PM and DM patients prognosis related factors. Results The mortality of 52 patients was 21.2%, the 1-year survival rate was 86.2%, the 3-year survival rate was 81.4%, the 5-year survival rate was 78.4%, and the 9-year survival rate was 74.6%. There were no factors closely related to the survival time. The patients with malignant tumor (P = 0.003), interstitial pneumonia (P = 0.006) and dysphagia (P = 0.004) had a higher case fatality rate than those without the disease. The patients who were cured and basically cured accounted for 60.7% of the patients who survived. The incidence of muscle function has nothing to do with the prognosis. Among the 52 patients with PM and DM, 9 were anti-Jo1 antibody positive (17.3%), of which 6 were PM positive (22.2%), 3 were DM positive (12.0%), 66.7% were anti-Jo1 positive , 33.3% with swallowing difficulties. Conclusion The long-term prognosis of patients with PM and DM is good, and most of the survivors are basically cured. Patients with malignant tumor, interstitial pneumonia and dysphagia have high mortality. Anti-Jo1 antibody positive patients with interstitial pneumonia and difficulty swallowing.