儿童急性良性肌炎的病例特点与治疗分析

Analysis of characteristics and treatment of benign acute childhood myositis

目的探讨儿童急性良性肌炎(BACM)的病例特点及治疗。方法回顾性选取2021年9月26日至2022年1月6日于河北省儿童医院心内科住院的BACM患儿47例。收集患儿病史、辅助检查结果、治疗和住院时间等临床资料。比较不同血清肌酸激酶水平患儿的腿痛持续时间。结果 纳入BACM患儿中男42例、女5例,年龄4~14岁、平均7.06岁。45例有呼吸道感染表现或前驱病史,2例有剧烈运动史。46例患儿以肌痛为主诉入院,主要表现为腿痛。发生呼吸道感染至出现肌痛时间为1~10 d、平均3.3 d。甲型流感病毒感染5例、乙型流感病毒感染24例、腺病毒感染2例、支原体感染5例。患儿血清肌酸激酶2 790.00(1 491.75,7 195.75)U/L、肌酸激酶同工酶23.52(15.08,52.72)μg/L。肌酸激酶>8 000 U/L 9例、2 000~8 000 U/L 23例、<2 000 U/L 15例,3组患儿腿痛持续时间分别为6.2(4.0,7.3)、3.5(2.5,4.2)、3.3(2.6,4.1)d,组间比较差异有统计学意义(Z=15.232,P<0.001)。47例患儿均采用综合治疗,流感病毒感染患儿给予奥司他韦口服,合并横纹肌溶解综合征患儿给予水化碱化补液治疗。住院时间5~9 d、平均5.9 d。结论BACM主要累及男性患儿,与病毒感染相关,尤其是乙型流感病毒,主要表现为肌痛和血清肌酸激酶升高,肌酸激酶升高的程度与病情严重程度相关。儿童BACM预后良好。

Objective To investigate the characteristics and treatment of benign acute childhood myositis(BACM). Methods Totally 47 children with BACM admitted to Children′s Hospital of Hebei Province from September 26, 2021 to January 6, 2022 were enrolled retrospectively. Clinical data such as medical history, auxiliary examination results, treatment and length of stay were collected. Duration of leg pain was compared among children with different levels of creatine kinase. Results There were 42 boys and 5 girls with BACM in this study. The age was 4-14 years and the mean was 7.06 years. Forty-five cases had respiratory infectious manifestations or prodromal history and 2 cases had strong exercise history. Forty-six cases were hospitalized with myalgia as the main complaint, mainly manifested as leg pain. The time from respiratory tract infection to myalgia was 1-10 d and the mean was 3.28 d. There were 5 cases of influenza A virus infection, 24 cases of influenza B virus infention, 2 cases of adenovirus infection and 5 cases of mycoplasma infection. The level of creatine kinase was 2 790.00(1 491.75,7 195.75)U/L, and the level of creatine kinase isoenzyme was 23.52(15.08,52.72)μg/L. Nine cases had creatine kinase>8 000 U/L, 23 cases had creatine kinase 2 000-8 000 U/L, and 15 cases had creatine kinase<2 000 U/L. The duration of leg pain in the three groups was 6.2(4.0,7.3), 3.5(2.5,4.2) and 3.3(2.6,4.1)d, respectively, and the difference was statistically significant(Z=15.232,P<0.001). All children were treated with comprehensive treatment. Children with influenza virus infection were given oseltamivir orally, and the child with rhabdomyolysis was given hydration andalkalization rehydration treatment. The length of stay was 5-9 d and the mean was 5.89 d. Conclusions BACM mainly affects boys and is associated with viral infection, especially influenza B virus, which is mainly manifested by myalgia and increased level of creatine kinase. The degree of increased creatine kinase is related to the severity of the disease and the prognosis is good.