Characteristics and prognostic implications of peripheral blood lymphocyte subsets in patients with anti-MDA5 antibody positive dermatomyositis-interstitial lung disease
Fang-Ping Ren, Qi Chen, Shanshan Yao, Feng Lin, Xinying Xue, Weichao Zhao, Dong Wang, Zhiling Zhao, Shizhou Gu, Ting Li, Yawen Shen, Lan Gao, Xuelei Zang, Xinyu Bao, Zhao-Hui Tong
Abstract
Abstract Objectives To examine the characteristics of blood lymphocyte subsets in dermatomyositis-interstitial lung disease (DM-ILD) inflicted patients with positive anti-melanoma differentiation-associated gene 5 (anti-MDA5), as well as its prognosis value in this set of patients. Methods Data were retrospectively collected from 253 DM-ILD patients from three hospitals in China between January 2016 to January 2021. Patients were grouped into anti-MDA5 antibody positive group (MDA5 + DM-ILD) and anti-MDA5 antibody negative group (MDA5 − DM-ILD) based on myositis-specific autoantibody test results. Demographic characteristics, lymphocyte subsets patterns and other clinical features were compared between the two groups. The association of lymphocyte subsets with 180-day mortality was investigated using survival analysis in MDA5 + DM-ILD. Results Out of 253 eligible patients with DM-ILD, 59 patients were anti-MDA5 + and 194 were anti-MDA5 − . Peripheral blood lymphocyte count, CD3 + count, percentage of CD3 + , CD3 + CD4 + count, and CD3 + CD8 + count was lower in MDA5 + DM-ILD than in MDA5 − DM-ILD − (all P < 0.001) as well as CD3 − CD19 + count ( P = 0.04). In MDA5 + DM-ILD, CD3 + CD8 + count ≤ 49.22 cell/μL (HR = 3.81, 95%CI [1.20,12.14]) and CD3-CD19 + count ≤ 137.64 cell/μL (HR = 3.43, 95%CI [1.15,10.24]) were independent predictors of mortality. CD3 + CD8 + count ≤ 31.38 cell/μL was associated with a higher mortality risk in all DM-ILD patients (HR = 8.6, 95%CI [2.12,31.44]) after adjusting for anti-MDA5 and other clinical characteristics. Conclusion Significant lymphocytes decrease was observed in MDA5 + DM-ILD patients. CD3 + CD8 + cell count was associated with worse prognosis in both MDA5 + DM-ILD and all DM-ILD patients.