铁蛋白增高提示皮肌炎可能继发急性间质性肺病

铁蛋白增高提示皮肌炎可能继发急性间质性肺病

刘 蕊

        摘要  目的：急性/亚急性间质性肺炎（A/SIP）是皮肌炎难治性且致命性的并发症。由于还没有一种有效的指标来预测皮肌炎A/SIP并发症的发生，因此我们来研究血清铁蛋白的浓度是否可以作为预测皮肌炎出现A/SIP并发症的预测指标。

        方法：入选患者中19例患A/SIP，24例患慢性间质性肺炎，21例没有间质性肺病（ILD）。通过医学记录获得临床表现及实验室数据。

        结果：皮肌炎伴A/SIP的患者组的血清铁蛋白水平显著升高，且比没有A/SIP的患者组铁蛋白显著升高(平均 790 vs 186 ng/ml; P < 0.0001). A/SIP组患者的累积生存时间达6个月的比例为62.7%，而且铁蛋白大于或等于1500ng/ml的患者累积生存率显著低于铁蛋白小于1500ng/ml组(P = 0.016)。

        结论：铁蛋白水平可以作为预测皮肌炎出现A/SIP并发症的预测指标，且与预后相关。对于存在高铁蛋白血症的伴ILD的皮肌炎患者，尤其是铁蛋白高于>1500 ng/Ml,应联合使用多种免疫抑制剂强化治疗。

        附原文 Abstract OBJECTIVES: Acute/subacute interstitial pneumonia (A/SIP) is an intractable and fatal complication of DM. Since a useful indicator predicting the complication of A/SIP has not been found, the aim of this study was to determine whether serum ferritin is a potential predictive indicator of the occurrence of A/SIP in 64 patients with DM. METHODS: Of the total patients enrolled, 19 had A/SIP, 24 had chronic interstitial pneumonia and 21 were without  interstitial lung disease (ILD). Clinical manifestations and laboratory data were obtained from medical records on admission.  RESULTS: Serum ferritin levels were extremely high in patients with DM with A/SIP. It was significantly higher in DM with A/SIP than that in DM without A/SIP (median 790 vs 186 ng/ml; P < 0.0001). The cumulative survival rate for 6 months was 62.7% in patients with DM with A/SIP. Moreover, the cumulative survival rate was significantly (P = 0.016) lower in the group with ferritin levels > r =1500 ng/ml than the rate in the group with ferritin levels <1500 ng/ml. CONCLUSIONS: Serum ferritin can be useful as a predictor of the occurrence of A/SIP and correlates with the prognosis of A/SIP in DM. The intensive treatment using combination therapy with various immunosuppressant agents should be chosen for patients with ILD with DM showing hyperferritinaemia, especially levels >1500 ng/ml.

        引自：Gono T, Kawaguchi Y, Hara M, Masuda I, Katsumata Y, Shinozaki M, Ota Y, Ozeki E, Yamanaka H. Increased ferritin predicts development and severity of acute interstitial lung disease as a complication of dermatomyositis. Rheumatology (Oxford). 2010 , 49(7):1354-60.