Page 57 - 南京医科大学自然版

第45卷第2期 蔡清清，尤含笑，王 磊，等. NLR和SII对抗MDA5抗体阳性皮肌炎伴快速进展型肺炎的预后价值［J］.
2025年2月 南京医科大学学报（自然科学版），2025，45（2）：196-207 ·197 ·

patients（31.45%）died during the follow⁃up period. The results of multivariate Cox regression analysis showed that the elevated NLR
was an independent risk factor for RPILD development，while the elevated SII expression was independently associated with the
increased mortality of RPILD. Based on the ROC curve analysis，NLR>6.12 was a predictor for RPILD，and SII >875.79 was associated
with increased mortality risk of RPILD. Conclusion：Both NLR and SII are accessible，cost⁃effective，and reliable prognostic indicators
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for the prognosis of patients with anti⁃MDA5 DM，providing a valuable guidance for clinical management and risk stratification of the
disease.
［Key words］ anti⁃melanoma differentiation⁃associated gene 5⁃positive dermatomyositis；neutrophil⁃to⁃lymphocyte ratio；rapidly pro⁃
gressive interstitial lung disease；systemic immune⁃inflammation index
［J Nanjing Med Univ，2025，45（02）：196⁃207］

Anti⁃melanoma differentiation⁃associated gene 5⁃ marker that reflects the balance between immune re⁃
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positive（anti ⁃ MDA5 ）dermatomyositis（DM）is a sponse and inflammation ［13，21- 24］ . The SII expression
unique subtype of idiopathic inflammatory myositis was associated with disease activity of RA，adult⁃onset
characterized by a high risk of developing interstitial Still’s disease，and ankylosing spondylitis，and it also
［1］
lung disease（ILD） . Among these patients，approxi⁃ served as a prognostic indicator in conditions such as
mately 38%-71% of patients develop into rapidly pro⁃ psoriasis，psoriatic arthritis，and anti⁃neutrophil cyto⁃
［2-3］
gressive interstitial lung disease（RPILD） ，a severe plasmic antibody ANCA⁃associated vasculitis ［22-27］ .
and life⁃threatening complication that is often resistant Studies found that the cytokine profiles of lung tis⁃
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to current treatment. Despite aggressive therapy，the all⁃ sues observed in patients with anti⁃MDA5 DM⁃associ⁃
cause mortality rate within six months of the patients ated RPILD had similarities to those seen in severe
remains as high as 40%-60% ［4-6］ . Several biomarkers， cases of COVID ⁃ 19，where both NLR and SII were
including the elevated expression of serum ferritin proven to be reliable predictors of disease severity and
［7-8］ ［9］ ［28-31］
（SF） ，Krebs Von den Lungen⁃6（KL⁃6） ，and lac⁃ mortality . These similarities suggest that NLR and
［10］
tate dehydrogenase（LDH） ，as well as the presence SII may be valuable and easily integrated markers in
of anti⁃Ro52 antibodies ［11-12］ ，have offered valuable in⁃ routine clinical practice for monitoring inflammation
sights into the progression of anti⁃MDA5 DM. However， and predicting outcomes in anti⁃MDA5 DM patients，
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because of the complexity and inherent variability of which remains to be further explored. Therefore，the
these markers，it highlights the urgent need for other current study investigated the potential of both NLR
novel and more reliable biomarkers that better predict and SII in predicting the prognosis of patients with anti⁃
+
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RPILD of anti⁃MDA5 DM patients in clinical practice. MDA5 DM.
The neutrophil ⁃ to ⁃ lymphocyte ratio（NLR）is a
1 Materials and methods
cost⁃effective and readily available indicator of systemic
inflammation，which is increasingly recognized in vari⁃ 1.1 Study subjects
ous inflammatory and autoimmune diseases，including The current single⁃center retrospective study was
sepsis，pneumonia，corona virus disease 2019（COVID⁃ conducted at the First Affiliated Hospital of Nanjing
19），rheumatoid arthritis（RA），systemic lupus erythe⁃ Medical University and enrolled patients with anti ⁃
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matosus，etc. ［13-14］ . High NLR was associated with poor MDA5 DM who received inpatient treatment between
prognosis in conditions like idiopathic pulmonary fibro⁃ March 2019 and September 2023. All DM cases met
sis，primary Sjögren’s syndrome，and RA ⁃ associated the diagnostic criteria of Bohan ⁃ Peter 1975 or Son⁃
［10，15-20］ ［32- 33］
ILD . theimer and were positive for MDA5 antibodies.
Similarly，the systemic immune⁃inflammation in⁃ The diagnosis of ILD was based on respiratory symp⁃
dex（SII），calculated as（platelet count × neutrophil toms，physical examination，and high ⁃ resolution CT
［34］
count）/lymphocyte count，is another promising bio⁃ （HRCT）findings . RPILD was defined as a progres⁃