中国人多发性肌炎/皮肌炎合并肾脏损害的临床特点(附文献复习)

Clinical characteristics of the polymyositis/dermatomyositis(PM/DM) patients with renal involvement in China

目的:研究中国人多发性肌炎/皮肌炎(PM/DM)合并肾脏损害的临床特点。方法:报道1例皮肌炎合并肾脏损害病例的临床特点,并检索中国人PM/DM合并肾脏损害的文献报道进行系统分析。结果:共纳入28例病例。其中男10例,女18例,男:女比为1:1.8。PM/DM合并肾脏病变时,急性肾损伤和慢性肾脏病变均存在。肾脏损害病理类型:局灶节段性肾小球硬化(40%)、系膜增生性肾小球肾炎(20%)、轻微肾小球病变(20%)、肾小管间质性肾炎(10%)、IgA肾病(10%)。28例PM/DM患者中,25例(89.3%)治疗后好转,尿蛋白转阴,肾功能正常;1例(3.6%)死亡;1例(3.6%)发展为终末期肾病,1例(3.6%)预后不详。结论:多发性肌炎/皮肌炎合并肾脏病变的临床表现,主要包括急性肾损伤和慢性肾脏病变。早期诊断与早期治疗是改善患者预后的关键。

Objective：To study the clinical characteristics of the polymyositis/dermatomyositis （PM/DM）patients with renal involvement in China.Methods：Here we reported a case of dermatomyositis complicated with renal involvement,and to retrieve all PM/DM with renal involvement reported in the literature from Chinese database.Resnits：Twenty-eight cases were enrolled in our study.Among these patients there were 10 males and 18 females,with a male to female ratio of 1 ：I.8.PM/DM combined with renal disease has both acute kidney injury and chronic kidney disease.Renal pathological types included：focal segmental glomerulosclerosis （40%）, mesangial proliferative glomerulonephritis （20%）,minor glomerular lesions （20%）,tubulointerstitial nephritis （10%）,IgA nephropathy （10%）.Among the 28 PM/DM patients,25 cases （89.3%）improved after treatment, urine protein negative and normal renal function;l case （3.6%）died;1 case （3.6%）developed end-stage renal disease, 1 case （3.6%）of prognosis is unknown.Conclusion：The clinical manifestations of polymyositis/dermatomyositis complicated with renal lesions include acute kidney injury and chronic kidney disease.Early diagnosis and treatment is the key to improve the prognosis of patients.