北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (6): 1001-1008. doi: 10.19723/j.issn.1671-167X.2020.06.003

• 论著 • 上一篇    下一篇

临床无肌病性皮肌炎与皮肌炎临床及免疫学特征比较

甘雨舟1,李玉慧1,张丽华2,马琳3,何文雯4,金月波1,安媛1,栗占国1,叶华1,()   

  1. 1. 北京大学人民医院风湿免疫科,北京 100044
    2. 呼伦贝尔市人民医院风湿免疫科,内蒙古呼伦贝尔市 021008
    3. 河北省中医院风湿免疫科,石家庄 050011
    4. 重庆医科大学附属第一医院内分泌内科,重庆 400016
  • 收稿日期:2020-07-27 出版日期:2020-12-18 发布日期:2020-12-13
  • 通讯作者: 叶华 E-mail:yehbmu@126.com
  • 基金资助:
    国家自然科学基金(81801615);国家自然科学基金(81871289);国家自然科学基金(81801617)

Comparison of clinical and immunological features between clinically amyopathic dermatomyositis and typical dermatomyositis

Yu-zhou GAN1,Yu-hui LI1,Li-hua ZHANG2,Lin MA3,Wen-wen HE4,Yue-bo JIN1,Yuan AN1,Zhan-guo LI1,Hua YE1,()   

  1. 1. Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rheumatology, Hulunbeier People’s Hospital, Hulunbeier 021008, Inner Mongolia, China
    3. Department of Rheumatology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang 050200, China
    4. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
  • Received:2020-07-27 Online:2020-12-18 Published:2020-12-13
  • Contact: Hua YE E-mail:yehbmu@126.com
  • Supported by:
    National Natural Science Foundation of China(81801615);National Natural Science Foundation of China(81871289);National Natural Science Foundation of China(81801617)

摘要:

目的:比较临床无肌病性皮肌炎(clinically amyopathic dermatomyositis, CADM)和皮肌炎(dermatomyositis, DM)的临床及免疫学特征。方法:选择2010年1月—2019年12月在北京大学人民医院风湿免疫科住院的106例CADM和158例DM患者的病例资料进行回顾性分析,对两组患者的临床及免疫学指标进行比较,探讨肌炎抗体在CADM和DM中的的分布特点及临床意义,其中,肌炎抗体的检测采用免疫印迹法。结果:在临床表现方面,与DM相比,CADM更多地以肺间质病变(interstial lung diseases, ILD)起病(20.7% vs. 7.6%, P=0.002),且以急性ILD为主(58.3% vs. 26%, P<0.001),而在皮疹、合并其他结缔组织病和恶性肿瘤等方面,CADM与DM差异无统计学意义,CADM类风湿因子和抗核抗体的阳性率均低于DM。CADM最常见的肌炎特异性抗体(myositis specific autoantibodies, MSAs)为抗黑色素瘤分化相关基因5(melanoma differentiation related genes, MDA5, 36%)、抗PL-7(11.2%)及抗TIF-1γ(10.1%);DM最常见的MSAs为抗Jo-1(19.2%)、抗TIF-1γ(11.5%)及抗MDA5(11.5%)。抗MDA5与急性ILD及皮肤破溃相关,但在CADM中皮肤破溃与抗MDA5的滴度无关,而在DM中皮肤破溃与高滴度的抗MDA5相关。在DM中,抗TIF-1γ与向阳疹、V领/披肩征、甲周炎,以及合并恶性肿瘤相关,且合并恶性肿瘤的比例与抗TIF-1γ的滴度无关;在CADM中,抗TIF-1γ与临床表现及合并症无明显相关性。CADM及DM中最常见肌炎相关抗体均为抗Ro-52,抗Ro-52在CADM中与雷诺现象和慢性ILD相关,在DM中与技工手、发热,以及合并其他结缔组织病相关。结论:与DM相比,CADM-ILD以急性为主,肌炎抗体在CADM与DM中具有不同的分布特点;同一种肌炎抗体在CADM及DM中的临床意义也存在区别,且部分肌炎抗体的临床意义还与滴度相关。

关键词: 皮肌炎, 临床无肌病性皮肌炎, 肌炎抗体

Abstract:

Objective: To study the differences between clinically amyopathic dermatomyositis (CADM) and typical dermatomyositis (DM) on clinical and immunological features. Methods: By collecting clinical data of 106 CADM patients and 158 DM patients from January 2010 to June 2019 in the department of Rheumatology and Immunology, Peking University People’s Hospital, the clinical characteristics and immunological features in the two groups were compared, and the distribution characters and the clinical meanings of myositis autoantibodies were discussed in the two groups respectively. Myositis autoantibodies were measured by immunoblotting according to the manufacturers’ instructions. Results: In the aspects of clinical manifestations, CADM presented more with onset of interstial lung diseases (ILD) compared with DM (20.7% vs. 7.6%, P=0.002), and CADM-ILD was more likely to be acute ILD (58.3% vs. 26%, P<0.001), and there were no differences between CADM and DM in cutaneous manifestations, accompanied with connective tissue disease (CTD) and malignancy. In CADM, the positive rate of rheumatoid factors and antinuclear antibodies was lower in DM. The most common myositis specific autoantibodies (MSAs) in CADM were anti-MDA5 (36%), anti-PL-7 (11.2%) and anti-TIF-1γ (10.1%). The most common MSAs in DM were anti-Jo-1 (19.2%), anti-TIF-1γ (11.5%) and anti-MDA5 (11.5%). Anti-MDA5 was correlated with acute ILD and skin ulceration both in CADM and DM; in CADM, skin ulceration was not associated with the titer of anti-MDA5; while in DM, skin ulceration was associated with high titer of anti-MDA5. In DM, anti-TIF-1γ was correlated with heliotrope eruption, V/shawl neck sign, perionychia erythma and malignancy, and higher rate of malignancy was seen in all titers of the anti-TIF-1γ positive patients. In CADM, anti-TIF1-γ showed no correlation with clinical manifestations. The most common myositis associated autoantibody was anti-Ro-52 both in CADM and DM. In CADM, anti-Ro-52 was associated with Raynaud’s phenomenon and chronic ILD, while in DM, anti-Ro-52 was associated with mechanic’s hands, noninfectious fever and accompanied CTD. Conclusion: Compared with DM, ILD is more likely to be acute in CADM. It is different between CADM and DM about the distribution of myositis autoantibodies and the clinical significance of the same myositis antibody, and the clinical significance of some myositis antibodies is related to titers.

Key words: Clinically amyopathic dermatomyositis, Dermatomyositis, Myositis autoantibody

中图分类号: 

  • R593.26

表1

CADM与DM的临床表现及实验室指标比较"

Items CADM (n=106) DM (n=158) F/χ2 P
Age/years, x-±s 50.47±12.44 51.63±13.85 0.484 0.487
Gender, female:male (%female) 82:24 (77.4) 109:49 (69.0) 2.222 0.136
Age of onset/years, x-±s 48.84±13.07 48.92±14.79 0.001 0.969
Cutaneous manifestation
Gottron’s sign/papule, n(%) 85 (80.2) 115 (72.8) 1.894 0.169
Mechanic’s hands, n(%) 41 (38.7) 56 (35.4) 0.286 0.593
Heliotrope eruption, n(%) 59 (55.7) 82 (51.9) 0.361 0.548
V shawl neck sign, n(%) 59 (55.7) 92 (58.2) 0.171 0.679
Skin ulceration, n(%) 13 (12.3) 17 (10.8) 0.143 0.706
Perionychia erythma, n(%) 21 (19.8) 35 (22.2) 0.208 0.648
Skin calcinosis, n(%) 7 (6.6) 8 (5.1) 0.281 0.596
Pulmonary involvement
ILD, n(%) 84 (79.2) 131 (82.9) 0.564 0.453
Acute, n(%) 49 (58.3) 34 (26.0) 22.640 <0.001
Asymptomatic, n(%) 17 (20.2) 43 (32.8) 4.030 0.045
ILD onset before CADM diagnosed, n(%) 22 (20.7) 12 (7.6) 9.792 0.002
Systemic symptoms
Noninfectious fever, n(%) 41 (38.7) 56 (35.4) 0.286 0.593
Arthralgia, n(%) 56 (52.8) 65 (41.1) 3.493 0.062
Raynaud phenomenon, n(%) 12 (11.3) 22 (13.9) 0.383 0.536
Splenomegaly, n(%) 11 (10.4) 10 (6.3) 1.383 0.240
Weight loss, n(%) 38 (35.8) 44 (27.8) 1.897 0.168
Accompanied CTD, n(%) 20 (18.9) 31 (19.6) 0.023 0.879
Accompanied malignancy, n(%) 5 (4.7) 14 (8.9) 1.631 0.202
Serum TAAs
CEA/(μg/L), M(P25, P75) 2.89 (1.76, 5.27) 2.00 (1.10, 4.03) 2.750 0.006
AFP/(μg/L), M(P25, P75) 2.45 (1.89, 3.17) 2.45 (1.78, 3.46) 0.297 0.767
CA19-9/(U/mL), M(P25, P75) 11.81 (4.97, 16.53) 9.92 (5.78, 18.87) 0.471 0.638
CYFRA21-1/(μg/L), M(P25, P75) 3.38 (2.05, 5.49) 3.06 (2.36, 4.81) 0.260 0.795
NSE/(μg/L), M(P25, P75) 14.08 (11.15, 17.20) 16.20 (12.39, 23.47) 2.848 0.004
Immunological parameters
RF positive, n(%)* 11 (10.8) 32 (20.5) 4.203 0.040
ANA (≥1:80), n(%)* 36 (35.3) 78 (50.0) 6.538 0.011

表2

肌炎抗体在CADM与DM中分布的比较"

Items CADM (n=89) DM (n=130) Comparison by
overall positive
rate
Comparison
by titers
Overall + ++ +++ Overall + ++ +++ χ2 P χ2 P
Myositis specific autoantibodies (MSAs)
Mi-2α 1 (1.1) 1 (1.1) 0 0 7 (5.4) 3 (2.3) 3 (2.3) 1 (0.8) - 0.146 3.124 0.077
Mi-2β 4 (4.5) 3 (3.4) 0 1 (1.1) 6 (4.6) 3 (2.3) 3 (2.3) 0 - 1 0.001 0.970
TIF-1γ 9 (10.1) 8 (9.0) 1 (1.1) 0 15 (11.5) 3 (2.3) 5 (3.8) 9 (6.9) 0.444 0.505 4.202 0.040
MDA5 32 (36.0) 6 (6.7) 6 (6.7) 20 (22.5) 15 (11.5) 5 (3.8) 2 (1.5) 8 (6.2) 20.65 <0.001 18.697 <0.001
NXP2 5 (5.6) 2 (2.2) 1 (1.1) 2 (2.2) 7 (5.4) 1 (0.8) 3 (2.3) 3 (2.3) 0.006 0.941 0.022 0.883
SAE1 3 (3.4) 0 0 3 (3.4) 1 (0.8) 0 0 1 (0.8) - 0.306 - 0.306
SRP 4 (4.5) 4 (4.5) 0 0 8 (6.2) 2 (1.5) 2 (1.5) 4 (3.1) - 0.765 2.108 0.147
Jo-1 7 (7.9) 2 (2.2) 2 (2.2) 3 (3.4) 25 (19.2) 2 (1.5) 3 (2.3) 20 (15.4) 5.47 0.019 7.255 0.007
PL-7 10 (11.2) 5 (5.6) 3 (3.4) 2 (2.25) 10 (7.7) 2 (1.5) 4 (3.1) 4 (3.1) 0.799 0.371 0.067 0.796
PL-12 7 (7.9) 1 (1.1) 1 (1.1) 5 (5.6) 7 (5.4) 3 (2.3) 0 4 (3.1) 0.543 0.461 1.034 0.309
EJ 0 (0.0) 0 0 0 10 (7.7) 1 (0.8) 1 (0.8) 8 (6.2) - 0.006 6.744 0.009
OJ 2 (2.2) 2 (2.25) 0 0 4 (3.1) 3 (2.3) 1 (0.8) 0 - 1 0.336 0.562
Myositis associated autoantibodies (MAAs)
PM-Scl100 6 (6.7) 5 (5.6) 1 (1.12) 0 5 (3.8) 1 (0.8) 1 (0.8) 3 (2.3) 0.928 0.335 0.055 0.815
PM-Scl75 6 (6.7) 3 (3.4) 1 (1.12) 2 (2.2) 9 (6.9) 2 (1.5) 4 (3.1) 3 (2.3) 0.003 0.958 0.089 0.766
Ku 9 (10.1) 4 (4.5) 2 (2.2) 3 (3.4) 4 (3.1) 2 (1.5) 1 (0.8) 1 (0.8) - 0.041 4.218 0.040
Ro-52 44 (49.4) 8 (9.0) 5 (5.6) 31 (34.8) 70 (53.8) 4 (3.1) 4 (3.1) 62 (47.7) 0 1 1.952 0.162
Both MSAs and
MAAs positive
79 (88.8) - - - 112 (86.1) - - - 1.143 0.285 - -
Only MSAs positive 62 (69.7) - - - 99 (76.1) - - - 0 0.989 - -
Only MAAs positive 54 (60.1) - - - 79 (60.8) - - - 0.323 0.570 - -

表3

在CADM与DM中肌炎抗体的临床表现及合并疾病的相关性的比较"

Items CADM DM
TIF-1γ MDA5 Ro-52 TIF-1γ MDA5 Ro-52
r P r P r P r P r P r P
Mechanic’s hands -0.058 0.524 0.117 0.275 0.101 0.344 0.004 0.961 0.058 0.509 0.196 0.026
Heliotrope eruption 0.025 0.818 0.165 0.123 -0.335 0.001 0.310 <0.001 0.146 0.098 -0.121 0.171
V/shawl neck sign 0.111 0.302 0.014 0.893 -0.157 0.141 0.280 0.001 0.127 0.151 -0.256 0.003
Skin ulceration -0.013 0.907 0.289 0.006 -0.167 0.117 -0.022 0.805 0.310 <0.001 0.013 0.882
Perionychia erythma 0.017 0.875 0.115 0.281 -0.148 0.167 0.287 <0.001 0.300 0.001 0.024 0.783
Skin calcinosis -0.078 0.465 -0.169 0.112 0.063 0.560 -0.087 0.323 -0.079 0.372 -0.179 0.042
Noninfectious fever 0.012 0.912 -0.015 0.892 0.094 0.381 -0.238 0.006 -0.082 0.354 0.257 0.003
Arthralgia -0.156 0.144 0.107 0.317 0.102 0.343 -0.165 0.060 0.204 0.020 0.141 0.109
Raynaud’s phenomenon -0.013 0.907 -0.106 0.322 0.246 0.020 -0.046 0.601 -0.025 0.775 0.052 0.556
Malignancy -0.070 0.516 -0.022 0.840 -0.078 0.465 0.476 <0.001 -0.124 -0.160 -0.102 0.247
Accompanied CTD -0.089 0.407 0.073 0.498 0.066 0.540 -0.135 0.124 -0.110 0.214 0.329 <0.001

表4

在CADM与DM中肌炎抗体与不同类型肺间质病变相关性的比较"

Items CADM DM
Non-ILD
(n=16)
Acute ILD
(n=44)
Chronic ILD
(n=29)
P Non-ILD
(n=22)
Acute ILD
(n=27)
Chronic ILD
(n=81)
P
TIF-1γ 3 (18.7) 5 (11.4) 1 (3.4) 0.234 8 (36.4) 0* 9 (11.1)* 0
MDA5 3 (18.7) 22 (50.0)* 7 (24.1)§ 0.027 0 8 (29.6)* 7 (8.6)§ 0.002
Jo-1 - - - - 1 (4.5) 7 (25.9)* 17 (21.0)* 0.039
Ro-52 4 (25.0) 21 (47.7) 19 (65.5)*§ 0.018 9 (40.9) 17 (63.0) 44 (54.3) 0.415

图1

不同滴度的肌炎抗体阳性的CADM患者临床表现的比较"

图2

不同滴度肌炎抗体阳性的DM患者临床表现的比较"

[1] Mariampillai K, Granger B, Amelin D, et al. Development of a new classification system for idiopathic inflammatory myopathies based on clinical manifestations and myositis-specific autoanti-bodies[J]. JAMA Neurol, 2018,75(12):1528-1537.
doi: 10.1001/jamaneurol.2018.2598 pmid: 30208379
[2] Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups[J]. Arthritis Rheumatol, 2017,69(12):2271-2282.
pmid: 29106061
[3] Sontheimer RD. Would a new name hasten the acceptance of amyopathic dermatomyositis (dermatomyositis siné myositis) as a distinctive subset within the idiopathic inflammatory dermato-myopathies spectrum of clinical illness[J]. J Am Acad Dermatol, 2002,46(4):626-636.
doi: 10.1067/mjd.2002.120621 pmid: 11907524
[4] Sato S, Kuwana M. Clinically amyopathic dermatomyositis[J]. Curr Opin Rheumatol, 2010,22(6):639-643.
doi: 10.1097/BOR.0b013e32833f1987 pmid: 20827200
[5] Muro Y, Sugiura K, Hoshino K, et al. Epidemiologic study of clinically amyopathic dermatomyositis and anti-melanoma differentiation-associated gene 5 antibodies in central Japan[J]. Arthritis Res Ther, 2011,13(6):R214.
doi: 10.1186/ar3547 pmid: 22192091
[6] McHugh NJ, Tansley SL. Autoantibodies in myositis[J]. Nat Rev Rheumatol, 2018,14(6):290-302.
[7] Gerami P, Schope JM, McDonald L, et al. A systematic review of adult-onset clinically amyopathic dermatomyositis (dermatomyositis siné myositis): a missing link within the spectrum of the idiopathic inflammatory myopathies[J]. J Am Acad Dermatol, 2006,54(5):597-613.
[8] Travis WD, Costabel U, Hansell DM, et al. An official American thoracic society/European respiratory society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J]. Am J Respir Crit Care Med, 2013,188(6):733-748.
pmid: 24032382
[9] Mukae H, Ishimoto H, Sakamoto N, et al. Clinical differences between interstitial lung disease associated with clinically amyopathic dermatomyositis and classic dermatomyositis[J]. Chest, 2009,136(4):1341-1347.
doi: 10.1378/chest.08-2740
[10] Ikeda S, Arita M, Misaki K, et al. Incidence and impact of interstitial lung disease and malignancy in patients with polymyositis, dermatomyositis, and clinically amyopathic dermatomyositis: a retrospective cohort study[J]. Springerplus, 2015,4:240.
doi: 10.1186/s40064-015-1013-8 pmid: 26101728
[11] Chen Z, Hu W, Wang Y, et al. Distinct profiles of myositis-specific autoantibodies in Chinese and Japanese patients with poly-myositis/dermatomyositis[J]. Clin Rheumatol, 2015,34(9):1627-1631.
doi: 10.1007/s10067-015-2935-9 pmid: 25903820
[12] Hoshino K, Muro Y, Sugiura K, et al. Anti-MDA5 and anti-TIF1-gamma antibodies have clinical significance for patients with dermatomyositis[J]. Rheumatology (Oxford), 2010,49(9):1726-1733.
doi: 10.1093/rheumatology/keq153
[13] Jablonski R, Bhorade S, Strek ME, et al. Recognition and management of myositis-associated rapidly progressive interstitial lung disease[J]. Chest, 2020,58(1):252-263.
[14] Long K, Danoff SK. Interstitial lung disease in polymyositis and dermatomyositis[J]. Clin Chest Med, 2019,40(3):561-572.
doi: 10.1016/j.ccm.2019.05.004 pmid: 31376891
[15] Liang J, Cao H, Ke Y, et al. Acute Exacerbation of interstitial lung disease in adult patients with idiopathic inflammatory myo-pathies: a retrospective case-control study[J]. Front Med (Lausanne), 2020,7:12.
[16] Ning Y, Yang G, Sun Y, et al. Efficiency of therapeutic plasma-exchange in acute interstitial lung disease, associated with polymyositis/dermatomyositis resistant to glucocorticoids and immunosuppressive drugs: a retrospective study[J]. Front Med (Lausanne), 2019,6:239.
[17] Temmoku J, Sato S, Fujita Y, et al. Clinical significance of myositis-specific autoantibody profiles in Japanese patients with polymyositis/dermatomyositis[J]. Medicine (Baltimore), 2019,98(20):e15578.
doi: 10.1097/MD.0000000000015578
[18] Ghirardello A, Doria A. New insights in myositis-specific autoantibodies[J]. Curr Opin Rheumatol, 2018,30(6):614-622.
pmid: 30234722
[19] Huang W, Ren F, Wang Q, et al. Clinical features of thirty-two patients with anti-melanoma differentiation-associated gene 5 antibodies[J]. Clin Exp Rheumatol, 2019,37(5):803-807.
pmid: 30767866
[20] Li L, Wang H, Wang Q, et al. Myositis-specific autoantibodies in dermatomyositis/polymyositis with interstitial lung disease[J]. J Neurol Sci, 2019,397:123-128.
doi: 10.1016/j.jns.2018.12.040
[21] Xu Y, Yang CS, Li YJ, et al. Predictive factors of rapidly progressive-interstitial lung disease in patients with clinically amyopathic dermatomyositis[J]. Clin Rheumatol, 2016,35(1):113-116.
doi: 10.1007/s10067-015-3139-z pmid: 26660480
[22] Trallero-Araguás E, Rodrigo-Pendás J, Selva-O’Callaghan A, et al. Usefulness of anti-p155 autoantibody for diagnosing cancer-associated dermatomyositis: a systematic review and meta-analysis[J]. Arthritis Rheum, 2012,64(2):523-532.
doi: 10.1002/art.33379 pmid: 21953614
[23] Fujimoto M, Murakami A, Kurei S, et al. Enzyme-linked immunosorbent assays for detection of anti-transcriptional intermediary factor-1 gamma and anti-Mi-2 autoantibodies in dermatomyositis[J]. J Dermatol Sci, 2016,84(3):272-281.
doi: 10.1016/j.jdermsci.2016.09.013 pmid: 27693019
[24] Cruellas MG, Viana Vdos S, Levy-Neto M, et al. Myositis-specific and myositis-associated autoantibody profiles and their clinical associations in a large series of patients with polymyositis and dermatomyositis[J]. Clinics (Sao Paulo), 2013,68(7):909-914.
doi: 10.6061/clinics
[25] Gan YZ, Zhang LH, Ma L, et al. Risk factors of interstitial lung diseases in clinically amyopathic dermatomyositis[J]. Chin Med J (Engl), 2020,133(6):644-649.
[26] Lee A. A review of the role and clinical utility of anti-Ro52/TRIM21 in systemic autoimmunity[J]. Rheumatol Int, 2017,37:1323-1333.
doi: 10.1007/s00296-017-3718-1 pmid: 28417151
[27] van Dooren SH, van Venrooij WJ, Pruijn GJ. Myositis-specific autoantibodies: detection and clinical associations[J]. Auto Immun Highlights, 2011,2:5-20.
doi: 10.1007/s13317-011-0018-8 pmid: 26000115
[28] Tansley SL, Snowball J, Pauling JD, et al. The promise, perceptions, and pitfalls of immunoassays for autoantibody testing in myositis[J]. Arthritis Res Ther, 2020,22(1):117.
pmid: 32414409
[29] Mecoli CA, Albayda J, Tiniakou E, et al. Myositis autoanti-bodies: a comparison of results from the oklahoma medical research foundation myositis panel to the euroimmun research line blot[J]. Arthritis Rheumatol, 2020,72(1):192-194.
doi: 10.1002/art.41088 pmid: 31430029
[30] Ikeda N, Yamaguchi Y, Kanaoka M, et al. Clinical significance of serum levels of anti-transcriptional intermediary factor 1-γ antibody in patients with dermatomyositis[J]. J Dermatol, 2020,47(5):490-496.
doi: 10.1111/1346-8138.15284 pmid: 32103537
[31] Wang T, Zheng XJ, Ji YL, et al. Tumour markers in rheumatoid arthritis-associated interstitial lung disease[J]. Clin Exp Rheu-matol, 2016,34(4):587-591.
[32] Jin Q, Zheng J, Xu X, et al. Value of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in evaluating severity and prognosis of connective tissue disease-associated interstitial lung disease[J]. Arch Rheumatol, 2018,33(2):190-197.
doi: 10.5606/ArchRheumatol.2018.6419 pmid: 30207560
[33] Dai H, Liu J, Liang L, et al. Increased lung cancer risk in patients with interstitial lung disease and elevated CEA and CA125 serum tumour markers[J]. Respirology, 2014,19(5):707-713.
doi: 10.1111/resp.12317 pmid: 24903079
[1] 张朴丽,杨红霞,张立宁,葛勇鹏,彭清林,王国春,卢昕. 血清YKL-40在诊断抗黑色素瘤分化相关基因5阳性皮肌炎合并严重肺损伤中的价值[J]. 北京大学学报(医学版), 2021, 53(6): 1055-1060.
[2] 吴燕芳,高飞,林滇恬,陈志涵,林禾. 托法替布联合治疗抗MDA5抗体阳性的无肌病皮肌炎并发快速进展型间质性肺病5例临床分析[J]. 北京大学学报(医学版), 2021, 53(5): 1012-1016.
[3] 徐婧,徐静,李鹤,唐杰,舒建龙,张婧,石连杰,李胜光. 皮肌炎合并IgA血管炎1例[J]. 北京大学学报(医学版), 2019, 51(6): 1173-1177.
[4] 杨伊莹,左晓霞,朱红林,刘思佳. 皮肌炎/多肌炎表观遗传学标志物的研究进展[J]. 北京大学学报(医学版), 2019, 51(2): 374-377.
[5] 余建峰, 金月波, 何菁, 安媛, 栗占国. 皮肌炎继发干燥综合征伴肺间质病变的血清人Ⅱ型肺泡细胞表面抗原变化1例[J]. 北京大学学报(医学版), 2017, 49(5): 910-914.
[6] 刘爽, 安媛, 贾园, 栗占国. 类风湿关节炎合并无肌病性皮肌炎伴多重肺损伤1例[J]. 北京大学学报(医学版), 2014, 46(5): 805-808.
[7] 陈芳, 舒晓明, 王冬雪, 王国春, 卢昕. 多发性肌炎及皮肌炎患者血清单核细胞趋化蛋白-1的测定及临床意义[J]. 北京大学学报(医学版), 2012, 44(2): 204-208.
[8] 姚海红, 李玉慧, 张学武, 栗占国. 皮肌炎合并甲状腺功能异常的临床及免疫学特征分析[J]. 北京大学学报(医学版), 2011, 43(2): 209-212.
[9] 李玉慧, 姚海红, 张学武, 栗占国. 94例皮肌炎患者器官受累及免疫学特征分析[J]. 北京大学学报(医学版), 2010, 42(2): 140-142.
[10] 沈光莉, 张巍, 李漪, 吕鹤, 袁云. 骨骼肌弥漫性钙化伴随皮下囊肿一例报告[J]. 北京大学学报(医学版), 2005, 37(6): 659-660.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究(英文稿)[J]. 北京大学学报(医学版), 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报(医学版), 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报(医学版), 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报(医学版), 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报(医学版), 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报(医学版), 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报(医学版), 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报(医学版), 2009, 41(3): 297 -301 .
[9] Jian-wei GU, Emily YOUNG, Zhi-jun PAN, Kevan B. TUCKER, Megan SHPARAGO, Min HUANG, Amelia Purser BAILEY. SD大鼠长期高盐饮食可导致其高血压并改变肾细胞因子基因表达谱[J]. 北京大学学报(医学版), 2009, 41(5): 505 -515 .
[10] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报(医学版), 2009, 41(5): 599 -601 .