资源描述：
《多发性肌炎-皮肌炎71例临床研究》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
1、多发性肌炎/皮肌炎71例临床研究【摘要】目的探讨多发性肌炎(PM)和皮肌炎(DM)患者的临床特点,以利临床诊断、指导治疗及判断预后。方法回顾性分析71例PM和DM患者的临床表现、肌酶水平、肌电图、肌活检以及转归,并对PM和DM进行分析比较。结果PM首发症状以发热肌痛、近端肌无力多见,DM则皮疹为首发症状。PM患者出现肌酶LDH,AST升高明显高于DM组患者,ILD在DM中发生率高于PM的,其差异具有统计学意义。PM的病理改变主要表现为散在肌纤维萎缩;DM以束周萎缩多见。影响预后的主要因素年龄、肺部感染,肿瘤有关。结论多发性肌炎和皮肌炎的临床特征及病
2、理各有不同。【关键词】多发性肌炎;皮肌炎;临床分析ClinicalAnalysisof71patientswithPolymyositis/DermatomyositisHUANWen-ying,YANGLin.KelamayiCentralHospital,Kelamayi834000,China【Abstract】ObjectiveToexploretheclinicalfeaturesofpatientswithpolymyositis(PM)anddermatomyositis(DM)toprovideevidenceforclinical
3、diagnosis,treatmentandprognosticevaluation.MethodsDataof71easesofPM/DM7concerningtheinitialsymptoms,subsequentmanifestations,muscleenzymes,eleetromyogram,musclebiopsyandprognosiswereanalyzedretrospectivelyandcompared.ResultsPatientswithPMweremorelikelytohavefever,myalgiaandmus
4、cleweaknessattheonset,whileskinlesionsweretheinitialsignsinmostofDMpatientsirrespectiveofdurationofthedisease.TheelevationofmuscleenzymeswasmorecommoninPMcomparedwithDM,andthechangesinCKamongPM/DMpatientswereofstatisticalsignificancebeforeandaftertreatment(P2.4合并肿瘤均为DM合并肿瘤,其中肺
5、癌2例,食道癌1例,年龄为64~80岁,平均73岁,而PM无合并肿瘤。2.5肌电图(EMG)57例患者有完整的EMG资料,PM8例,阳性率为100%,其中6例呈肌源性损害(75%),混合性损害1例,神经源损害1例,正常0例;DM49例,阳性率为83.69%,其中34例呈肌源性损害(69.4%),混合性损害4例,神经性损害3例,正常8例。PM和DM的EMG半数以上呈肌源性损害。2.6实验室检查血清肌酶学在7两组患者中,乳酸脱氢酶(LDH)、谷草转氨酶(AST)均值以PM组高,与DM组比较有统计学差异(P0.05)。大多数肌炎患者,随着症状的改善,复查
6、肌酶下降甚至恢复正常范围,且以CK的动态变化最为明显,并与病情活动度呈正相关。IgG,IgM,IgA,ESR,CRP在两组中无统计学差异。见表2。表2各组实验室检查结果(x±s)例数性别(男/女)年龄(月)病程(月)IgGIgMIgA抗Jo-1抗体(%)PM41/345.42±18.3716.72±23.101760.83±922.89228.35±135.77274.08±124.430DM298/2148.16±14.9519.75±37.781442.22±709.56174.91±106.53298.56±174.4117.24P值0.58
7、10.7910.1930.1450.649CK(U/L)LDH(U/L)AST(U/L)HBDH(U/L)ESR(mm/1h)CRP(mg/l)PM4137.35±4971.88983.24±716.26231.92±6215.07536.77±13364.5355.83±33.531.83±2.137DM1128.59±1710.92610.47±507.20113.64±148.14318.12±214.2142.88±29.531.40±1.92P值0.0610.0350.0230.0670.1880.4942.7肌活检PM5例和DM36例有
8、完整肌活检病理资料。其中DM有1例未见异常炎症反应。2.8治疗结果与转归疗效判断:好转为肌力增加1级或1级以上;无变化为肌
