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目的:探讨皮肌炎或多发性肌炎(DM/PM)并发心脏损害(cardiacinvolvement,CI)的临床特点及危险因素。方法:收集近3年来住院的91例DM/PM患者临床资料,采用Logistic回归及ROC曲线进行回顾性分析。结果:56例DM/PM患者并发CI,并发率为61.5%,其中心电图异常39例、超声心动图异常21例、心力衰竭3例、心肌梗死1例。单因素Logistic回归分析显示肌病类别、性别、年龄、病程、肌力、心悸症状、雷诺现象、血清肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、CK-MB/CK比值与DM/PM并发CI无显著相关,肺间质病变、AST/CK比值与DM/PM并发CI显著相关;多因素Logistic回归分析显示肺间质病变、AST/CK比值都与DM/PM并发CI显著相关。ROC曲线分析显示以AST/CK比值0.172作为判断DM/PM并发CI的临界值时,判断灵敏度71.4%、特异度60%。结论:DM/PM常并发亚临床表现的CI,肺间质病变、AST/CK高比值水平是DM/PM并发CI的危险因素。
Objective: To investigate the clinical features and risk factors of dermatomyositis or polymyositis (DM / PM) complicated with cardiacinvolvement (CI). Methods: The clinical data of 91 DM / PM patients hospitalized in recent 3 years were collected and analyzed retrospectively by Logistic regression and ROC curve. Results: Fifty-six patients with DM / PM complicated with CI had a concurrent rate of 61.5%. There were 39 cases of electrocardiogram abnormality, 21 cases of abnormal echocardiography, 3 cases of heart failure and 1 case of myocardial infarction. Univariate Logistic regression analysis showed that myopathy, gender, age, course of disease, muscle strength, palpitation symptoms, Raynaud’s phenomenon, serum creatine kinase (CK), myocardial creatine kinase isoenzyme (CK-MB), aspartate The ratios of AST and CK-MB / CK were not significantly correlated with DM / PM complicated with CI. The interstitial lung disease, AST / CK ratio were significantly correlated with DM / PM complicated with CI. Multivariate logistic regression analysis showed that the lung Quality disease, AST / CK ratio and DM / PM were significantly correlated with CI. ROC curve analysis showed that when the AST / CK ratio was 0.172, the sensitivity and the specificity were 71.4% and 60% respectively. Conclusions: CI, interstitial lung disease and high AST / CK ratio of DM / PM are the risk factors of DM / PM complicated with CI.