[Analysis of immunological characteristics of dermatomyositis patients with myocardial involvement]

Zhonghua Yi Xue Za Zhi. 2020 Mar 17;100(10):753-756. doi: 10.3760/cma.j.cn112137-20190815-01812.
[Article in Chinese]

Abstract

Objective: To investigate the clinical and immunological features of cardiac involvement in patients with dermatomyositis (DM). Methods: Data of 271 adult patients with DM diagnosed in the Department of Rheumatology and Immunology, Peking University People's Hospital from 2003 to 2018 were collected retrospectively and analyzed statistically. Results: The occurrence of cardiac involvement in DM was 15.9% (43/271). Main feature of cardiac involvement in DM was elevated cardiac troponin I (cTnI). The most common abnormalities of ECG were T wave abnormality (27.9%, 12/43), sinus tachycardia (16.3%,7/43), ST-T change (14%, 6/43) and right bundle branch block (7%, 3/43). The common manifestations of echocardiography were left ventricular diastolic dysfunction (23.3%, 10/43) and pericardial effusion (23.3%, 10/43). As compared with DM patients without cardiac involvement, DM patients with cardiac damage were more likely to have rapidly progressive interstitial lung disease (ILD), skin damage, anemia, elevated creatine kinase, decreased C3 and serum albumin (P<0.05). Positive anti-Ro-52 antibody and Jo-1 antibody were detected more common in DM with cardiac involvement(P<0.05). Conclusions: Cardiac damage is common complication of DM. Manifestations of cardiac damaging are varied. Rapid progressive ILD and positive Jo-1 and Ro-52 antibodies are more common in this group. Clinicians should improve the awareness of cardiac involvement in DM patients.

目的: 探讨皮肌炎(DM)患者心脏受累的临床及免疫学特征。 方法: 回顾性分析2003至2018年于北京大学人民医院风湿免疫科住院的271例成人皮肌炎患者的资料,包括一般情况、皮肤、肌肉损害特征及实验室指标(包括炎性标志物、自身抗体等),并将心脏有无受累进行分组比较。 结果: 皮肌炎患者心脏受累的发生率为15.9%(43/271)。心脏受累的患者表现为心肌肌钙蛋白(cTnI)升高,常见的心电图异常为T波异常(27.9%,12/43)、窦性心动过速(16.3%,7/43)、ST-T改变(14%,6/43)及右束支传导阻滞(7%,3/43);超声心动图异常为左室舒张功能减退(23.3%,10/43)、心包积液(23.3%,10/43)。心脏受累组患者易出现皮肤破溃及合并间质性肺炎(ILD),该组患者发生急进性间质性肺炎的比例明显高于无心脏受累组(30.2%,13/43)。心脏受累的皮肌炎患者更易出现贫血、肌酸激酶升高及补体C3、血白蛋白低下,差异有统计学意义(P<0.05)。抗Ro-52抗体、抗Jo-1抗体在心脏受累组多见,与无心脏受累组比较差异有统计学意义。 结论: 心脏损害是皮肌炎患者的常见并发症,心脏受损表现多样,主要表现为cTnI升高,该组患者易合并急进性ILD及抗Ro-52、Jo-1抗体阳性,病情活动度高。.

Keywords: Anti-Jo-1 antibody; Cardiac; Dermatomyositis; Interstitial lung disease.

MeSH terms

  • Adult
  • Dermatomyositis*
  • Echocardiography
  • Humans
  • Lung Diseases, Interstitial
  • Retrospective Studies