风湿性多肌痛症6例临床体会

Clinical analysis of 6 cases with polymyalgia rheumatica

目的：探讨风湿性多肌痛症的临床特点,提高临床医师对该病的认识,减少误诊、改善患者预后。方法：回顾性分析皖南医学院附属弋矶山医院风湿免疫科自2006年8月至2007年8月间明确诊断的6例风湿性多肌痛症患者的病历资料。结果：①6例患者均为女性,中位年龄60岁,病程2-12个月;②6例中4例颈、肩胛带、骨盆带及四肢近端肌群疼痛,另2例仅骨盆和四肢近端肌群疼痛;③治疗前6例中位红细胞沉降率（ESR）77.5 mm/h,C反应蛋白（CRP）4例升高,2例正常,中位数61.31 mg/L,类风湿因子（RF）均正常,抗核抗体（ANA）5例阴性,1例阳性;6例肌酸激酶（CPK）均正常;④5例患者行肌电图检查,4例提示肌源性损害,1例正常,4例行肌肉活检,结果均无异常;⑤6例均使用皮质激素治疗（起始用量为泼尼松0.5 mg/（kg.d））,5例明显好转（疼痛缓解,ESR、CRP恢复正常）。所有患者均无头痛、视力障碍等巨细胞动脉炎的临床依据。结论：风湿性多肌痛症多见于中老年人,肌电图可以有肌源性损害,国人并发巨细胞动脉炎少见,正确认识本病,减少误诊和漏诊,尽早给予合理治疗是改善预后的关键。

Objective：To study clinical characteristic of polymyalgia rheumatica（PMR）for improving the knowledge of this disease to prevent physicians from misdiagnosing it.Methods：The data of 6 patients with PMR from Yijishan Hospital between Aug.2006 and Aug.2007 were analyzed retrospectively in terms of clinical manifestations and laboratory tests.Results：① All the six patients were females with a median age of 60 years.The interval from onset to diagnosis ranged from 2 to 12 months.② 4 of the 6 patients complained of myalgia around the neck,shoulder girdle,hip girdle and the proximal portions of the extremities,and another 2 complained of only in hip girdle and the proximal portions of the extremities.③ Median ESR was 77.5mm/h and level of C-reactive protein（CRP） elevated in 4 patients,but the level of rheumatoid factor and creatine kinasse were normal in the six patients before treatment.④ 4 patients were found with lesions of muscles by electromyographic scanning,but with normal histologic features by muscle biopsy.⑤The six patients received medication of steroid（initial dose of 0.5 mg/（kg·d） prednisone） and 5 patients responded well.Conclusion：PMR is more commonly seen in elderly people.Electromyogram may reveal the lesion of muscles.Although giant cell arteritis is rarely seen in patients with PMR,early diagnosis and medication is recommended to improving prognosis.