皮肌炎/多发性肌炎127例临床分析

Clinical analysis of 127 cases of DM/PM

目的 探讨DM/PM的临床表现、主要诊断要点和疗效.方法 分析了127例住院病例资料.结果 初发症状以皮损(52.8%)和皮损肌炎同发(31. 5%)多见,而仅有肌炎者占14.9%.皮损以上眼险及眶周浮肿性紫红色斑(85.2%),Gottron丘疹(58.3%),甲周红斑(43.5%)和皮肤异色病样改变(43.5%)多见.肌炎以四肢近端(82.3%)和吞咽肌群(44.9%)多见.此外可见血清肌浆酶和24 h尿肌酸排出量增加,肌电图异常,少数合并恶性肿瘤及心肌受累.皮质激素治疗有效,与MTX合用能提高疗效.结论 眼睑及眶周浮肿性紫红色斑,四肢近端肌无力、肌痛、肌力减退及24 h尿肌酸排出量增加为主要诊断要点.皮质激素治疗有效,合用MTX能提高疗效.

Objective To explore the clinical manifestations, diagnostic points and curative effect of dermatomyositis/polymyositis (DM/PM). Methods Data of the 127 patients with DM/PM were reviewed and analysed. Results Primary symptoms included the dermatic lesions (52- 8%) and the dermatic lesions in company with myositis (31.5%). The rate of a single myositis is 14. 9%. Among the dematic lesions, the incidence of the purplish red spots around eyelids and orbits is 85. 2% ; the Gottron papules, 58. 3% ; the red spots around nails and the other abnormal colors on skin, 43. 5% respectively. Myositis, were seen in the muscule groups of the extremities proximal (82. 3%) and in the swallowing muscles (44. 9%) . Level of plasma myogenase and urocreatin output were found to be raised. The patients shown abnormal myoelectric gram (76%). Myositis was discovered pathologically. Some cases were complicated by malignant tumor (6. 3%) and myocardiac damage (9. 4%) respectively. Steroid hormones was effective for DM/PM, and the efficiency can be improved with additional MTX. Conclusion The main diagnostic points of DM/PM are purplish red sports around eyelids and orbits, myasthenia and myalgia of the proximal extremities, and increased urocreatin output in 24h. Treatment with cortical hormones is effective, when combined with MTX the curative effect can be inproved.