伴有眼外肌麻痹的多发性肌炎

Ophthalmoplegia in polymyositis

目的探讨多发性肌炎眼外肌受累的特点。方法收集1例以眼外肌麻痹为突出表现的多发性肌炎叠加综合征患者临床病理资料并结合文献总结在炎性肌病中眼外肌受累的特点。结果(1)实验室检查:肌酸激酶6498U/L,抗核抗体(1:320)阳性(均质型),肌电图提示肌源性受损,重频刺激试验阴性;(2)肌肉活检:可见明显的肌纤维变性坏死、吞噬现象及局灶性淋巴细胞浸润,MHC-I免疫组化染色可见广泛肌纤维图MHC-I表达阳性以及炎性细胞浸润MHC-I表达阳性的正常肌纤维。结论眼外肌麻痹是炎性肌病的少见表现。在眼外肌麻痹的鉴别诊断时应考虑到炎性肌病的可能性。

Objective To investigate the characteristics of ophthalmoplegia in polymyositis. Methods To collect clinical and pathological findings of a patient who presented prominent ophthalmoplegia and review the related literatures. Results （1）Laboratory examinations showed CK was 6498U/L and ANA （1：320） was positive; EMG showed myogenic changes and repetitive stimulus test was negative. （2）Biopsies of muscle showed marked degeneration, necrosis, phagocytosis, and inflammatory infiltration of muscles. MHC-I immuno-histostaining showed positive in most fibers and inflammatory infiltration of normal fibers with MHC-I expression. Conclusion Ophthalmoplegia is a rare manifestation in polymyositis. Idiopathic inflammatory myopathy should be considered in differential diagnosis of ophthalmoplegia.