多发性肌炎与皮肌炎(附20例临床分析)

Polymyositis And Dermatomyositis(with 20 Cases Report)

目的 探讨多发性肌炎与皮肌炎的临床特点。方法 回顾性地分析了 2 0例多发性肌炎与皮肌炎患者的临床资料 ,并结合文献复习其肌电图表现、病理特点、肌酶变化特点及治疗进展。结果 2 0例均表现出不同程度和不同部位的肌无力和肌萎缩 ,部分病例伴有皮肤损害和其他系统的损害。大部分病例肌酶均明显升高 ,肌电图以肌源性损害为主 ,异常率达 95 %。 6例肌肉活检的病理表现出特征性的改变。结论 多发性肌炎和皮肌炎是一组以肌无力和肌萎缩为主要表现的自身免疫性疾病 ,本病的诊断应结合临床资料、肌酶和肌电图检查 ,有条件应行肌肉活检进行确诊 ,同时应进行全身各系统的全面检查寻找可能存在的恶性疾病。治疗可用激素、免疫抑制剂等 ,也可试用免疫球蛋白和甲基强地松龙冲击治疗。

Objective To explore clinical characters of polymyositis(PM) and dermatomyositis(DM). Methods We analysed clinical data retrospectively for 20 patients with PM/DM, and reviewed concerned references of EMG manifestation, serum enzyme changes, pathologic characters and development for treatment. Results Myasthenia and muscular atrophy were visible at different muscle in different degrees among the groups. Skin lesion and other systematic symptoms involved several of them. Majority cases showed remarkable increased level in serum enzyme. Whilst abnormal EMG focus on muscular source, the abnormality opportunity is up to 95%. Pathologic test based on the muscular biopsy showed specific changes. Conclusion PM/DM is a kind of autoimmune disease which main characters are myasthenia and muscular atrophy. Physician should combine clinical information, serum enzyme changes, EMG manifestation together to make clear diagnosis. Muscular biopsy are strongly recommended if condition permits. Due to potential opportunity of carcinomas coexisting with PM/DM, physician also should take thoroughly physical check-up to find or exclude potential systemic carcinomas. Conventional corticosteroid and immunoinhibitor are effective for PM/DM, also immunoglobulin G iv supply and methyprednisolone pulse treatment might be helpful for the refractory cases.