多发性肌炎合并重症肌无力三例报告并文献复习

Myasthenia gravis complicated with polymyositis： a report of three cases and literature review

对本院收治的3例多发性肌炎（PM）合并重症肌无力（MG）患者的临床资料进行分析。3例均有肌酶升高，肌电图均示肌源性损害，重复低频电刺激及新斯的明试验均阳性，诊断为PM合并MG明确，分别随访1年、16个月和16年未复发。结合国内外文献，共有28例PM合并MG患者，平均年龄为56岁，临床表现依次为肌无力28例（100％），呼吸困难12例（43％），吞咽困难12例（43％），上睑下垂12例（43％），构音障碍8例（29％），复视5例（18％），饮水呛咳4例（14％），肌痛3例（11％），13／26例（50％）重复神经电刺激示低频波幅递减，21／23例（91％）乙酰胆碱受体抗体阳性，10／11例新斯的明试验阳性。

Three female patients admitted with elevated creatine kinase, impaired muscle on electromyogram, and positive repetitive nerve stimulation and neostigmine tests were diagnosed as polymyositis （PM） with myasthenia gravis （MG）. Twenty five more cases were retrieved by literature search, and the clinical data of total 28 cases were analyzed. There were 10 males and 18 females with an average age of 56 years. The clinical manifestations include dyspnea （43%）, dysphagia（43% ）, ptosis （ 43 % ） , dysarthria （ 29 % ） , diplopia （ 18 % ） , cough after drinking （ 14% ） , myalgia （ 11% ）. Thirteen out of 26 cases （50%） had positive results in repetitive nerve stimulation （RNS） and 10/11 showed positive reaction in neostigmine test. Serum positive anti-acetylcholine receptor was detected in 21 out 23 patients （91%）.