劳力性热射病致横纹肌溶解症八例临床病理分析

Clinicopathological analysis on eight patients with rhabdomyolysis caused by exertional heat stroke

目的探讨劳力性热射病致横纹肌溶解症的临床病理特点。方法8例患者中6例为在高温环境中进行军事训练的士兵，2例为在高温下体育锻炼者，其临床表现符合热射病诊断标准。全部患者均进行了血液生化学检查，3例进行了肌电图检查和肌肉活体组织检查，对其临床病理资料进行了分析。结果8例患者均为男性，平均年龄27．4岁，表现为肌痛者4例，无力者2例，发热5例，棕色尿3例，1例并发急性肾功能衰竭，2例出现多脏器功能衰竭和播散性血管内凝血。1例发病后第3天肌肉活体组织检查证实存在肌肉坏死而无炎性反应，2例在发病2周后肌肉活体组织检查示肌肉坏死伴炎性吞噬反应。经治疗6例治愈，1例好转，1例死亡。结论劳力性热射病所致横纹肌溶解症以男性较多，临床表现主要为肌痛、无力，血肌酸激酶和肌红蛋白明显升高，肌红蛋白尿。肌肉病理早期可见肌细胞坏死、溶解，后期出现炎性细胞浸润。如能及时诊断和正确治疗，多数患者可获康复，严重者可危及生命。

Objective To investigate the clinicopathological features and the pathogenesis of rhabdomyolysis caused by exertional heat stroke. Methods Eight patients including 6 military soldiers and 2 physical exercisers trained under high temperature environment were enrolled into this study. Their clinical manifestations were compatible with the diagnostic standard of exertional heat stroke. Consecutive blood biochemistry tests were performed in all patients, and electromyography and muscle biopsy in 3 cases. Results Eight patients were all male, with average age of 27.4 years old. The main clinical characteristics included myalgia in 4 patients, muscle weakness in 2 patients, fever in 5 patients, and tea-colored urine in 3 patients. One patient had acute renal failure, and 2 patients developed multiple organ failure syndromes and disseminated intravascular coagulation. One muscle biopsy done in the third day after the onset showed obvious muscle necrosis without inflammatory infiltrates, while the other 2 muscle biopsy done 2 weeks after the onset showed muscle necrosis companied by inflammatory phagocytic response. Six patients full recovered, 1 patient partially recovered and one patient died. Conclusions Rhabdomyolysis caused by exertional heat stroke predominantly occurred in males. The main clinical features include muscle pain, weakness, significantly elevated serum creatine kinase and myoglobin level and myoglobinuria. Muscle pathology indicated muscle necrosis in the early stage and accompanied inflammatory infiltrates in the late stage. Most patients will get recovered with prompt diagnosis and treatment while the severe cases can be life-threatening.