特发性炎性肌病119例肌肉活检病理分析

Pathological types of muscle biopsy from patients with idiopathic inflammatory myopathies:a retrospective clinicopathologic analysis of 119 cases

目的 探讨特发性炎性肌病 (IM )的肌肉活检病理类型及其临床病理联系。方法 回顾性分析IM的病理改变 ,归纳出各病理类型的特点。随访并评估IM患者的预后情况。结果 在119例IM中 ,重、中、轻度坏死性肌炎分别为 11例、19例和 2 7例 ,束周坏死 /萎缩性肌炎 2 0例 ,无炎细胞浸润的坏死性肌炎 2 2例 ,间质性肌炎 11例 ,肌筋膜炎 3例 ,包涵体肌炎 4例 ,肉芽肿性肌炎和增生性肌炎各 1例。其中 72例获得随访资料 ,轻度坏死性肌炎和束周坏死 /萎缩性肌炎患者的好转和治愈的百分比高于中、重度坏死性肌炎患者 ,间质性肌炎和无炎细胞浸润的坏死性肌炎的好转和治愈百分比高于重度坏死性肌炎。结论 IM的病理类型对判断预后具有重要的参考价值。

Objective To investigate the pathological classification and clinicopathological relationship of idiopathic inflammatory myopathies.Methods Muscular pathological features were summarized on the basis of severity and pattern of muscle fiber necrosis and inflammatory infiltrations.The relationship between pathological types and clinical manifestations as well as prognosis was analyzed.Results One hundred and nineteen cases of IM were pathologically classified into 10 types,including severe necrotic IM (11cases),moderate necrotic IM (19 cases),mild necrotic IM (27 cases),perifascicular necrotic/atrophic IM (20 cases),non inflammatory necrotic IM (22 cases),interstitial myositis (10 cases),inclusion body myositis (4 cases),muscular fasciitis (3 cases),granulomatous myositis (1 case),and proliferative fasciitis myositis (1 case).Seventy two cases were followed up to investigate the prognosis on the basis of pathological types.The results showed that the frequency of patients remitting and totally recovering were significantly higher in mild necrotic IM and perifascicular necrotic /atrophic IM than that in severe and moderate necrotic IM.Conclusion The pathological types of IM are valuable for the evaluation of prognosis in patients with IM.