特发性多发性肌炎复发规律的观察

Study on the Relapses of Idiopathic Polymyositis

目的探讨特发性多发性肌炎(idiopathic polymyositis,IPM)复发的特点及可能相关的因素。方法回顾性分析作者医院45例IPM患者的临床资料。结果45例IPM患者中复发19例,复发率为42.2%,复发总次数为28次,9例(47.4%)多次复发,年复发次数0.59次/人。复发于皮质类固醇激素减量后期者占57.9%,稳定维持治疗阶段者占31.6%,减量初期者占10.5%。复发诱因包括疲劳、精神刺激和感染。复发与无复发者在年龄、性别、病情严重程度、吞咽困难、肺部并发症、最初血清CK水平、红细胞沉降率等方面差异无统计学意义(P<0.05)。复发者激素与免疫抑制剂的联合应用比率低于无复发者(P<0.05)。IPM复发率于4个季节均衡分布(P<0.05)。结论IPM多复发于皮质类固醇激素减量后期,与性别、年龄、临床特点及血清CK等无关;单独使用激素治疗者易复发;复发与季节无关。

Objective To investigate the charateristics of relapses in idiopathic polymyositis （IPM）, and some related factors. Methods Clinical data of 45 IPM patients were analyzed retrospectively. Results 19 out of 45 IPM patients relapsed, the relapse rate was 42.2%. Total relapse frequency were 28 times, 9 cases （47.4%） experienced repeated relapses. Annual relapse frequency was 0.59/person on average. 57.9% of the patients relapsed in the later stage of corticosteroids decrement, 31.6% in thestable stage, 10.5% in the initial stage of the decrement. Relapsing inducements were fatigue, mind irritation and infection. There were no significant deviation in ages, genders, severity of the disease, dysphagia, implication of lung, initial serum CK level, erythrocyte sedimentation rate among relapsing and non relapsing patients （P〉0.05）. The rate of receiving corticosteroids combinating with immunosupprecssants treatment was significantly lower in relapsing patients than non-relapsing ones （P〈0.05）. Relapsing incidence distributed equilibriumly in four seasons, and there was no statistically differences among them （P〉0.05）. Conclusions Relapse mostly happened in the later stage of corticosteroids decrement level, etc. Patients using Relapse was independent of ages, genders, corticosteroids alone were prone to relapse. clinical characteristics and initial serum CK Relapse was not related to seasons.