四川东北地区多发性肌炎与皮肌炎患者的临床及实验室特征比较

Comparison of the Clinical and Laboratory Characteristics of Polymyositis and Dermatomyositis in the Northeastern Region of Sichuan Province

目的探讨多发性肌炎(PM)与皮肌炎(DM)患者的临床与实验室特征,为临床诊断、治疗及预后判断提供临床依据。方法选取2014年1月1日至2018年6月30日于川北医学院附属医院就诊的119例PM/DM患者为研究对象,按照疾病种类分为DM组(n=66)和PM组(n=53),分析两组患者误诊情况、临床症状、实验室指标、肺部高分辨率CT(HRCT)、治疗与预后情况。结果66.0%(35/53)PM患者首发症状为肌无力,较DM多见(P<0.01);40.9%(27/66)DM患者首发症状为皮疹;病程中PM组患者下肢近端肌无力、雷诺现象、干咳发生率高于DM组(P<0.05)。PM组肌炎酶学指标、白细胞、超敏C反应蛋白水平高于DM组(P<0.05);抗Jo-1抗体阳性率高于DM组(P<0.05)。HRCT结果示PM相关肺间质病变(PM-ILD)的网格影发生率高于DM相关肺间质病变(DM-ILD)(P<0.05)。结论PM和DM分别以肌无力和皮疹为初发症状,两组下肢近端肌无力、雷诺现象、干咳、酶学指标、白细胞、超敏C反应蛋白、抗Jo-1抗体、肺部HRCT表现均不同。

Objective To explore the clinical and laboratory characteristics of polymyositis(PM)and dermatomyositis(DM)so as to provide clinical evidence for clinical diagnosis,treatment guidance and prognostic evaluation.Methods A total of 119 patients with PM or DM treated in Affiliated Hospital of North Sichuan Medical College from January 1 st,2014 to June 30 th,2018 were selected as the research objects and divided into the PM group(n=66)and DM group(n=53)according to the types of diseases.The clinical data including misdiagnosis,clinical symptoms,laboratory indicators,high-resolution computed tomography(HRCT)results of lungs,therapeutic effect and prognosis in the two groups were analyzed retrospectively.Results Firstly,the incipient symptom in 66%(35/53)of PM patients was myasthenia and the proportion was significantly higher than that of DM patients(P<0.01).The incipient symptom in 40.9%(35/66)of DM patients was rash.The incidences of lower limb proximal myasthenia,Raynaud’s phenomenon and dry cough in the PM group were significantly higher than those of the DM group(P<0.05).Secondly,the levels of myositic enzymological indicators,leukocyte and hypersensitive C-reactive proteins and the positive rate of anti-Jo-1 antibody in the PM group were significantly higher than those in the DM group(P<0.05).Thirdly,the results of HRCT showed that the incidence of grid-form shadow in patients with PM combined with interstitial lung disease(PM-ILD)was significantly higher than that in patients with DM combined with interstitial lung disease(DM-ILD)(P<0.05).Conclusion Myasthenia and rash were the incipient symptoms of PM and DM respectively.The two groups had different manifestations in lower limb proximal myasthenia,Reynolds’phenomenon,dry cough,enzymological indicators,leukocyte,high-sensitivity C-reactive proteins,anti-Jo-1 antibody and lung HRCT results.