系统性红斑狼疮伴肌炎的临床研究

Clinical Study on the Patients with Systemic Lupus Erythematosus Associated with Myositis

目的探讨系统性红斑狼疮(SLE)伴肌炎患者的临床特点及其意义。方法采用对照研究方法 ,检测了64例SLE伴肌炎患者和43例皮肌炎(DM)患者的血清肌酶、肌电图、肌肉活检等 ,并做统计学分析。结果SLE肌炎的发生率为35 5 % ,症状轻 ,有轻度肌萎缩 ;与DM比较肌无力不明显(P<0 01) ;未见吞咽困难 ;SLE伴肌炎患者病情活动发生率[75 %(48/64)]高于非肌炎组[43 9 %(29/66)] ,有显著性差异(P<0 01) ;肌酶有所升高 ,但升高幅度均不超过正常值的50 % ,与DM患者比较有显著性差异(P<0 01) ;肌电图肌炎检出率为74 4 %(32/43) ,与DM组81 4 %(35/43)比较无显著性差异(P>0 05) ;肌活检显示 :肌间质血管炎 ,淋巴细胞和组织细胞浸润明显 ;肌纤维灶性肿胀 ,匀质变性 ,横纹模糊 ,未见坏死断裂 ,病变轻微。结论SLE肌炎较为常见 ,与SLE活动相关 ,症状轻 ,肌酶升高幅度小 ;肌电图与DM无异 ;肌活检间质病变明显 ,肌纤维病变轻微 ,有明显的临床和病理特征而有别于DM。

Objective To study the clinical features and sigificance of systemic lupus erythematosus(SLE) patients associated with myositis Methods A comparative study of 64 cases of systemic lupus erythematosus (SLE) associated with myositis and 43 cases of dermatomyositis(DM) was carried out by the observation of clinical features, serum levels of muscle enzymes, electromyographic pattern and muscle biopsies Results The results showed there were 35 5% of patients with SLE associated with myositis The myositis symptoms, muscle weakness and atrophy in these patients were less significant than those of DM (P< 0 01) The abnormal esophageal motility was not seen in these patients Although the serum level of muscle enzymes in SLE patients with myositis was elevated, the level was significantly lower than that of DM patients(P< 0 01) Electromyographic abnormality accounted for 74 4%(32/43) of SLE patients with muscle involvement, and the difference was not significant from that of DM patients (P >0 05) Muscle biopsy showed that there were obvious interstitial vasculitis with infiltration of lymphocytes and histiocytes, focal swelling and homogeneous degeneration of mucscle fibers, and no necrosis fragmentation was observed Conclusion SLE myositis has its distinct clinical and pathological characteristics which are different from those of DM