风湿性多肌痛的临床特点及误诊分析

Polymyalgia rheumatiea:Clinical features and misdiagnosis

目的:探讨风湿性多肌痛(PMR)患者的临床特点及误诊分析。方法:收集2018年8月~2020年5月首诊为PMR的12例住院患者初诊时及治疗后的临床资料以及治疗随访情况,根据12例患者不同转归结果分为PMR组和非PMR组,比较两组差异并做误诊分析。结果:两组患者在年龄、性别、病程、晨僵时间、临床症状及超声表现等方面差异均无统计学意义(P>0.05)。基线时非PMR组单核细胞/淋巴细胞比值高于PMR组(P<0.05),血白蛋白低于PMR组(P<0.05)。PMR组经小剂量糖皮质激素(泼尼松10 mg/d)治疗3个月后疾病活动度下降,差异具有统计学意义(P<0.05)。结论:单核细胞/淋巴细胞比值、白蛋白及对小剂量糖皮质激素的良好应答,或许可以作为鉴别PMR与以PMR症状起病的其他疾病的潜在指标;超声在PMR鉴别诊断中的价值有限。

Objective:To investigate the clinical characteristics and misdiagnosis of polymyalgia rheumatic(PMR).Methods:Clinical data were collected from patients of PMR at initial diagnosis,after treatment and follow-up.The 12 patients included in current study were treated on hospitalization basis in our hospital between August 2018 and May 2020,and divided into PMR group and non-PMR group according to the outcomes following therapy.Misdiagnosis was analyzed for the two groups of patients.Results:There were no significant differences in age,gender,course of disease,duration of morning stiffness,clinical symptoms and ultrasonic manifestations between the two groups(P>0.05),yet patients in the non-PMR group had higher monocyte/lymphocyte ratio and lower serum albumin than those in PMR group at baseline(both P<0.05).After treatment with low dose of glucocorticoid(prednisone 10mg/d)for 3 months,the disease activity was significantly decreased in patients in PMR(P<0.05).Conclusion:Monocyte/lymphocyte ratio,serum albumin,and better response to low doses of glucocorticoid may serve as potential indicators for differentiating PMR from other diseases initiated with PMR symptoms,yet ultrasound is narrow value in differential diagnosis of PMR.