45例皮肌炎临床分析

The analysis of clinical features of dermatomyositis of 45 cases

目的探讨皮肌炎的临床特点。方法回顾性分析45例皮肌炎患者的临床资料。结果患者48.9%以皮炎为首发症状。95.6%有四肢近端肌无力,4.4%有呼吸肌受累。37.5%有心电图异常及心肌损害。12%有间质性肺炎。乳酸脱氢酶(LDH)和肌酸磷酸激酶(CK)阳性率分别为100%和51.1%。肌肉病理肌炎性和肌电图肌原性改变分别占85%和90%,合并肺癌、食管癌各1例。死亡2例,分别死于肺癌和呼吸肌受累肺部感染。结论肌酶的检查对于较早期肌肉病变比肌电图具有更高的敏感性。CK敏感性低于LDH,CK特异性高。有心肌、呼吸肌受累、肺间质纤维化、合并肿瘤者,预后差。CK水平与预后无明显相关性。

Objective To explore clinical features of dermatomyositis. Methods 45 cases of patients were reviewed, Results The 48.9% patients had rashes at the initial presentation. The 95.6% patients had symmetric proximal muscle weakness. The 4. 4% patients had respiratory muscle involvement. The 37.5% patients had abnormal electrocardiogram and myocardic injure, The 12% patients had pulmonary interstital fibrosis. The positive rates of lactate dehydrogenase （LDH） and creatine kinase （CK） were 100% and 51.6% respectively. The rates of myositis change in muscle biopsy and myogenic： damage in electromyography were 85 % and 90% respectively. Associated malignancy had lung cancer, esophageal eancer. Two patients died of lung cancer and respiratory muscle involvement respectively. Conclusion Muscle enzymes are more sensitive than electromyography in early diagnosis of dermafomgositis. Creatine kinase is more specific than lactate dehydrogenase. Patients who had myoeardical strain and respiratory muscle involvement, pulmonary interstitial fibrosis, associated tumors predict a poor prognosis. There is no obvious correlation between the level of CK and the prognosis,