皮肌炎合并感染106例临床分析

The clinical study of dermatomyositis associated with infection

目的探讨皮肌炎合并感染患者的临床特征及其与其他并发症的关系。方法对武汉市皮肤病防治研究所和华中科技大学同济医学院附属同济医院2000～2009年间收治的106例皮肌炎初诊患者的住院资料进行回顾性分析，分析比较合并感染病例（34例）与未合并感染病例（72例）的临床特征和辅助检查资料。结果皮肌炎合并感染组的肌无力、吞咽困难、抗核抗体阳性（ANA〉1：100）率及伴发问质性肺炎的发生率分别为85．29％、50。00％、62．07％和35．29％，非感染组上述分别为65．28％、16．67％、48．65％和2．78％，两组比较差异有统计学意义（P值分别为〈0．05、〈0．01、〈0．01和〈0．01），感染组与非感染组的面部红斑、V区红斑、Gottron征、肌痛、肌电图呈肌源性改变及伴发恶性肿瘤等比较差异则无统计学意义。皮肌炎合并感染组患者的丙氨酸氨基转移酶、AST、肌酸激酶、乳酸脱氢酶水平分别为（124．67±86．27）IU／L、（213．41±153．01）IU／L、（1614．06±617．26）IU／L和（578．88±578．88）IU／L），非感染组分别为（52．75±31．02）IU／L、（81．17±58．73）IU／L、（348．5±129．45）IU／L和（314．19±187．21）IU／L，两组比较差异有统计学意义（P值分别为〈0．001、〈0．001、〈0．01和〈0．001）。结论皮肌炎患者出现明显肌酶升高、肌无力、吞咽困难、抗核抗体（ANA）阳性及伴发间质性肺炎时应密切注意合并感染的发生。

Objective To investigate the clinic features of dermatomyositis with infection,and its relationship with other complications. Methods 106 hospital patients with dermatomyositis from depart- ment of dermatology of Wuhan Tongji hospital were retrospectively analyzed to study the relationship between infections and other complications, and contrastively analyzed the clinical features and laboratory findings between 34 cases with infection and 72 cases without infection. Results The clinical manifestations such as weakness, difficulty swallowing, gottron sign, combination with interstitial pneumonitis and anti-nuclear antibody positive in dermatomyositis with infection group were more conspicuous than those in dermatomyositis without infection group. However, there were no significant differences between infection group and non-infection group in other clinical, manifestations, such as facial erythema, V District erythema, myalgia, abnormal EMG, and combination with malignant tumors, etc. Muscle enzyme test results （ such as ALT, AST, CK and LDH） showed significantly increased in dermatomyositis patients with infection than in those without infection. Conclusions We should pay close attention to patients of dermatomyositis with infection when muscle enzyme （ ALT, AST, CK, LDH） increased significantly, muscle weakness was noticeable, difficulty swallowing occurred, and gottron sign and ANA were showed positively.