多发性肌炎和皮肌炎消化道受累的临床研究

Clinical analysis of gastrointestinal involvement in polymyositis and dermatomyositis

目的:研究多发性肌炎(PM)和皮肌炎(DM)合并消化道受累的发生率、临床表现特点及危险因素。方法:回顾性分析中日友好医院风湿免疫科1986年3月～2010年6月住院的192例PM/DM患者的临床表现、辅助检查、实验室参数的特点,比较伴消化道受累与不伴消化道受累的PM/DM患者的差异。结果:192例患者中82例(42.7%)合并消化道受累:其中吞咽功能障碍71例,食道裂孔功能障碍8例,食管炎4例,食道蠕动减弱10例,胃蠕动减弱6例,胃张力减低2例,伪膜性肠炎1例,肠气囊肿1例。在PM和DM中,上述消化道受累类型的发生率无显著性差异。消化道受累组与不合并消化道受累组在诊断、性别方面无统计学差异;前者平均发病年龄小于后者,抬头困难的发生率较后者高,间质性肺疾病的发生率低于后者(均P<0.05)。其他常见临床表现,如四肢无力、Gottron征及向阳性皮疹的发生率、实验室检查中的肌酸激酶、血沉、C反应蛋白的升高程度在2组间无显著差异。结论:发病年龄较轻及有抬头困难的PM/DM患者更易合并消化道受累,而合并肺间质疾病的PM/DM患者消化道受累率相对较低。

Objective：To investigate the incidence,clinical feature,risk factors of gastrointestinal involvement in polymyositis（PM）and dermatomyositis（DM）.Methods：Clinical and laboratory data of the patients diagnosed with PM or DM between Mar.1986 and Jun.2010 in the hospital were collected and compared in patients with and without gastrointestinal involvement.Results：Out of 192 patients there were 82 cases（42.7%）with gastrointestinal involvement.Of which 71 had dysphagia,8 had oesophageal hiatus disorder,8 had esophagitis,10 had oesophageal motility disorders,6 had weakened peristole,2 had decreased gastric tonus,1 had pseudomembranous enteritis and 1 had pneumatosis cystoides intestinalis.There were no statistical significance between the two groups in diagnosis（PM/DM）and sexuality,but the average onset age was younger in the group with gastrointestinal involvement than the group without gastrointestinal involvement,and the incidence of difficulty in raising head was higher in the former group than the latter one,while the incidence of interstitial lung disease was lower in the latter group（all P0.05）.No significant difference were observed in other clinical features like general fatigue,Gottron＇s sign,heliotrope erythra,neither in laboratory parameters like creatinekinase,erythrocyte sedimentation rate or C reative protein.There were no significant difference in types of gastrointestinal involvement between patients with PM and those with DM.Conclusion：Gastrointestinal involvement more frequently occurred in younger PM/DM patients and those with difficulty in raising heads,while ILD seems negative correlated with gastrointestinal involvement in PM/DM patients.