风湿性多肌痛45例临床分析

Clinical analyses of polymyalgia rheumatica in 45 patients

目的:分析风湿性多肌痛的临床特点及治疗反应,提高对风湿性多肌痛的认识。方法:回顾分析皖南医学院附属弋矶山医院风湿免疫科2007～2011年住院及门诊确诊为风湿性多肌痛的45例患者的临床表现和治疗反应。结果:①女性多见,男女比为1∶5.43,女性发病年龄低于男性,病程长于男性。②临床以累及肩胛带肌和骨盆带肌痛多见,其次为发热和关节痛,乏力及体质量下降相对少见。③所有患者均有血沉(ESR)和C反应蛋白(CRP)升高。轻中度贫血31例(68.89%),免疫球蛋白升高18例(40%),肝功能异常8例(17.78%),血小板异常5例(11.11%)。④41例(91.11%)患者需要泼尼松或泼尼松联合甲氨蝶呤治疗,单纯非甾体抗炎药治疗4例(8.89%)。结论:PMR多见于50岁以上老年患者,以肩胛带及骨盆带肌肉疼痛和晨僵多见,ESR≥50 mm/1 h伴CRP升高,小剂量激素治疗显效。

Objective： To analyze the clinical features of polymyalgia rheumatica（PMR） and its response to certain treatment for better understanding of this disorder. Methods：The clinical features and the treatment response were retrospectively analyzed in 45 patients on out-patient treatment basis in our department between 2007 and 2011. Results：（1）PMR occurred more common in women than men with a ratio of 1 ： 5.43, and it affected younger women and had a longer disease duration as compared with men. （2） The shoulder girdle muscles and the pelvic girdle myalgia were more affected, followed by fever and joint pain, yet fatigue and weight loss were relatively rare. （3） Increased erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were seen in all patients. Of the total cases, mild to moderate anemia was seen in 31 （ 68.89 % ） , elevated immunoglobulin in 18 （40%） , abnormal liver function in 8 （ 17.78% ） , and platelet abnormalities in 5 （11. 11%）. （4） Forty-one cases （91.11% ）required single medication of prednisone or combined prednisone and methotrexate, and 4 （ 8.89% ） were managed with simple nonsteroidal anti-inflammatory agent. Conclusion ： PMR more common in elderly patients over 50 years with morning stiffness（MST） and the shoulder girdle muscles and the pelvic girdle involvement as well as increased ESR ≥ 50 mm/1 h and elevated CRP. Small dosage of hormone therapy may relieve this disorder.