文章摘要
基于深度学习的胸部CT定量分析评估托法替布治疗皮肌炎的疗效及安全性
Quantitative analysis of chest CT with deep learning to assess the efficacy and safety of tofacitinib in the treatment of dermatomyositis
投稿时间：2025-01-20  
DOI：10.3969/j.issn.1000-0399.2025.10.003
中文关键词: 皮肌炎  托法替布  改善病情的抗风湿病药物  深度学习方法  高分辨率计算机断层扫描
英文关键词: Dermatomyositis  Tofacitinib  DMARDS  Deep-learning method  High-resolution computed tomography
基金项目:江苏省卫生健康委医学科研项目(编号:H2023087)
作者单位E-mail
尤娜 210008 江苏南京 南京大学医学院附属鼓楼医院风湿免疫科  
辛小燕 210008 江苏南京 南京大学医学院附属鼓楼医院医学影像科  
苏彤 210008 江苏南京 南京中医药大学鼓楼临床医学院医学影像科  
王丹丹 210008 江苏南京 南京大学医学院附属鼓楼医院风湿免疫科 dandanwangffd@nju.edu.cn 
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中文摘要:
      目的 评估托法替布治疗皮肌炎（DM）患者的疗效和安全性。方法 回顾性队列分析于2018年1月至2023年5月南京鼓楼医院住院治疗的153例DM患者资料，根据是否使用托法替布治疗分为观察组（使用托法替布治疗，n=65）和对照组（未使用托法替布治疗，n=88），所有患者均随访。基于高分辨率计算机断层扫描（HRCT）定量分析评估两组患者间质性肺病（ILD）转归，比较两组患者生存率，统计不同人口学资料患者的病死率，记录治疗后不良反应发生率，评估托法替布治疗DM患者的疗效及安全性。结果 除抗黑色素瘤分化相关基因5（MDA5）抗体阳性率外，两组患者一般资料差异均无统计学意义（P>0.05）。Kaplan-Meier生存曲线显示，观察组5年生存率高于对照组（P=0.041），尤其在皮肤受累（HR=0.238，95%CI：0.068~0.830，P=0.024）、肌肉受累（HR=0.127，95%CI：0.016~0.989，P=0.049）、血沉升高（HR=0.219，95%CI：0.062~0.771，P=0.018）的患者中，使用托法替布可有效降低患者病死率。基于HRCT定量分析评估ILD转归，两组患者基线全肺病灶体积百分比差异有统计学意义（P=0.024）；治疗后，观察组全肺病灶体积百分比减少值高于对照组（P=0.015），但使用托法替布可增加患者EB病毒感染的风险（P=0.027）。结论 托法替布能有效控制DM患者ILD病情，提高生存率，可作为治疗DM的潜在选择，但在治疗过程中需关注感染的发生；HRCT定量分析可用于评估DM患者ILD的转归。
英文摘要:
      Objective To assess the efficacy and safety of tofacitinib in the treatment of dermatomyositis (DM). Methods This retrospective cohort analysis included 153 patients with DM who were hospitalized at Nanjing Drum Tower Hospital between January 2018 and May 2023. According to the use of tofacitinib or not, patients were categorized into the observation group (treated with tofacitinib, n=65) and the control group (not treated with tofacitinib, n=88), with all patients followed up. The efficacy and safety of tofacitinib in the treatment of DM were assessed based on quantitative analysis of high-resolution computed tomography (HRCT) to evaluate the regression in interstitial lung disease (ILD) in the two groups. The survival rate was compared, the mortality rate of patients with different demographic data was counted, and the incidence of post-treatment adverse effects was recorded. Results Except for the positive rate of anti-melanoma differentiation-associated gene 5 (MDA5) antibody, there was no statistically significant difference in the general information between the two groups (P>0.05). KaplanMeier survival curves showed that the five-year survival rate was higher in the observation group than in the control group (P=0.041). Especially in patients with skin involvement (HR=0.238, 95%CI: 0.068-0.830, P=0.024), muscle involvement (HR=0.127, 95%CI: 0.016-0.989, P= 0.049), and higher erythrocyte sedimentation rate (HR=0.219, 95%CI: 0.062-0.771, P=0.018), the use of tofacitinib was effective in reducing the mortality rate. Based on quantitative HRCT analysis to assess ILD condition, the difference in the percentage of baseline whole lung lesion volume between the two groups was statistically significant (P=0.024). The decreased percentage of whole-lung lesions volume after treatment was higher in the observation group than in the control group (P=0.015). However, tofacitinib increased the risk of EBV infection (P=0.027). Conclusion Tofacitinib is effective in controlling interstitial pneumonia and improving survival rates in patients with DM, and may be a potential therapeutic option for the treatment of DM. However, attention should be paid to the occurrence of infections during treatment. Quantitative HRCT analysis can be used to assess the severity of lung lesions in patients with DM-ILD.
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