63例横纹肌溶解综合征病例的临床分析

Rhabdomyolysis： clinical analysis of sixty three cases

目的探讨不同原因致横纹肌溶解综合征（RM）的临床特点及疾病转归情况。方法回顾性分析2010年1月至2016年8月南京地区63例RM患者的临床资料。结果病史：致病因素呈多样性，主要为食用龙虾、剧烈运动、降脂药所致，少数系感染、心脏电除颤及酒精引起，还有原因不明者。临床特点：主要表现为不同程度肌肉酸痛、酱油色尿及乏力，少数出现发热、呼吸窘迫及声音嘶哑等，不同病因引起RM的临床表现无差异；其中11例RM患者出现急性肾损伤，致病因素无明显偏倚。实验室检查（中位数），肌酸激酶6400U／L、谷草转氨酶399U／L、乳酸脱氢酶816U／L、d一羟丁酸445U／L和血肌红蛋白1200,18,／ml；选取肌酸激酶及肌红蛋白作为肌肉损伤程度的衡量指标，结果两者在各致病因素组间差异无明显统计学意义（P〉0．05）；肾小管功能指标如尿渗透压、尿视黄醇蛋白及尿N-乙酰-β-D氨基葡萄糖苷酶异常所占百分比分别为62．5％、50％、47．6％。治疗：对于无基础疾病、无并发症的患者通过水化补液、碱化尿液等处理，均痊愈出院；而出现急性肾损伤的11例患者，1例放弃治疗，5例行血液透析，余5例保守对症处理后，肌酐均下降至其发病前基础水平出院。结论不同致病因素导致的RM，其在临床症状、肌肉损伤程度、是否并发急性肾损伤及治疗预后方面，均无明显差异；加强对RM疾病认识，早期诊断和治疗对保护肾小管功能、预防急性肾损伤及改善预后尤其重要。

Objective To investigate clinical feature, therapy and prognosis of 63 （rhabdomyolysis, RM） patients. Methods Retrospective analysis was used for the 63 patients who were from Nanjing from Janurary 2010 to August of 2016. Results Clinical history： the pathogenic factors mainly contained eating lobster, excessive exercise, lipid-lowering drugs, and minority patients were induced by infection, cardiac defibrillation, alcohol, and unexplained factors. Clinical features： most patients presented different degree of muscle soreness and weakness, and urine color of soy sauce; and few patients manifested a fever, respiratory distress and sound hoarse. Of which 11 RM patients concurrent acute kidney injury （AKI） , there was no obvious bias of pathogenic factors among 11 patients. Clinical examination： the data was de- scribed by median, including creatine kinase 6 400 U/L, aspartate aminotransferase 399 U/L, lactate dehy- drogenase 816 U/L, α-hydroxybutyric acid 445 U/L, and myoglobin 1 200 ng/ml. Creatine kinase and myoglobin were selected to measure muscle injure, there was no significant difference among the groups （ P 〉 0. 05）. Renal tubular injury index such as urineosmotie pressure, urine retinol-binding protein and N-ace- tyl-beta-D-glucosaminidase （NAG） enzyme, the abnormal percentage were 62. 5% , 50% , and 47.6%. Treatment： patients without complications through resting, water infusion, urine alkalization, were cured; and 11 cases of patients with AKI, 1 case gave up, 5 cases underwent hemodialysis, and 5 cases underwent conservative treatment, creatinine decreased to the basic level. Conclusions Among different pathogenic factors of RM, there were no obvious differences in clinical symptom, muscle damage degree, and whether the coexistence of AKI and prognosis. The understanding of RM, early diagnosis and treatment would prevent AKI and improve the prognosis.