多发性肌炎/皮肌炎误诊98例分析

目的探讨多发性肌炎/皮肌炎(PM/DM)的误诊原因。方法从万方数据库上查询国内2000-2010年发表的PM/DM误诊文献共计14篇,其中误诊的病例数96例,以及我科新近收治的2例,回顾性分析98例患者的临床资料。结果 PM/DM是一种误诊率较高的疾病,误诊的疾病达28种,以误诊为呼吸系统疾病最多(45例,占45.92%)。结论 PM/DM可累及多个系统和器官,容易误诊。     

成人多发性肌炎及皮肌炎患者的护理

目的探讨多发性肌炎及皮肌炎患者的护理。方法对30例多发性肌炎及皮肌炎患者的治疗效果及护理体会进行总结。结果本组30例患者,1例因呼吸衰竭死亡,1例因感染死亡,放弃治疗1例,27例因病情好转出院。结论根据患者的情况有针对性地进行护理是保证治疗效果的关键。     

多发性肌炎／皮肌炎患者临床研究分析

目的：对多发性肌炎和皮肌炎（PM／DM）疾病的临床表现、疾病转归及预后进行分析．方法：选1995年1月至2008年8月收住兰州大学第二医院风湿科的54例PM／DM患者的资料进行回顾性分析．并经过统计学处理。结果：54例PM／DM患者的临床表现、实验室特点与文献报道一致。病死率为16．67％，各年龄组间病死率差异无统计学意义（P〉0．05）。结论：PM／DM以肌无力、肌痛及皮肤损害为主要临床表现，以血清学肌酸肌酶（CK）、乳酸脱氢酶（LDH）的升高和抗核抗体（ANA）阳性为主要实验室改变。病情重、有并发症提示预后不良。     

多发性肌炎/皮肌炎自身抗体谱的研究进展

多发性肌炎/皮肌炎是一种较常见的风湿性疾病。由于其临床表现的多样性和复杂性,易造成误诊和漏诊。随着免疫学的进展,除了常用的诊断方法外,对自身抗体的检测也受到重视。多发性肌炎/皮肌炎的自身抗体主要包括3大类肌炎特异性抗体、肌炎相关性抗体和组织特异性抗体。对这些自身抗体的研究有助于疾病的诊断、分型、疾病活动情况和预后的判断等。     

皮肌炎和多发性肌炎的护理

目的：探讨皮肌炎和多发性肌炎的护理措施。方法：回顾性分析80例皮肌炎和多发性肌炎患者的治疗效果和护理体会。结果：本组80例患者,病情好转出院72例,放弃治疗3例,死亡5例。结论：提高护理人员对疾病的认识及做好心理护理和皮肤护理,根据临床表现和并发症提供恰当、有效的护理是保证治疗效果的关键。     

99例多发性肌炎和皮肌炎临床分析

目的:了解PM/DM的临床及实验室表现。方法:分析PM/DM首发症状,心血管症状、呼吸系统症状、肌酶变化等。结果:首发症状有肌无力、肌痛、呼吸困难,吞咽困难,雷诺征,关节痛或关节炎,心肌炎,发热,未梢神经炎。心血管症状发生率15·2%,呼吸系统症状发生率53·3%。结论:PM/DM是一种累及多系统的疾病,易合并恶性肿瘤。     

多发性肌炎或皮肌炎心脏损害

多发性肌炎或皮肌炎(polymyositis/dermatomyositis,PM/DM)是一种以侵犯横纹肌为主的全身性炎症性肌病,主要临床表现是肌肉无力及疼痛,病理表现为骨骼肌组织中炎症细胞浸润。心脏受累是PM/DM常见的并发症,也是引起PM/DM患者死亡的常见原因之一[1],但PM/DM临床表现隐匿,往往得不到应有的重视,治疗也较为困难,为此本文就PM/DM心     

多发性肌炎和皮肌炎10例临床分析

多发性肌炎和皮肌炎是一组与自身免疫有关的炎症性肌病。近几年国内对本病报告渐多。现将我院从1989～1995年收治的10例报告如下。     

多发性肌炎与皮肌炎特殊情况分析

多发性肌炎（PM）与皮肌炎（DM）属结缔组织疾病,首先由Wagner于1863年描述,主要表现为肌肉无力和疼痛、皮肤各种皮疹。临床无皮肤症状为PM,有皮肤症状为DM。本病常与其它自身免疫病并存,约15％～20％与恶性肿瘤并存［’］。1968年,世界神经病学研究协会将其分为三类：①无并发症的PM——属于器官特殊性的自体免疫性疾病,即原发性PM;②有并发症的PM或DM——非器官特殊性的多系统性自体免疫性疾病,可与其它结缔组织病并发;③发生了肿瘤疾病的PM与DM［幻。现将收治的PM11例、DM2例报道如下。三四麻田料1．1一般资料13例中…     

多发性肌炎／皮肌炎的呼吸系统损害

多发性肌炎(PM)和皮肌炎(DM)是一种以侵犯骨骼肌为主的系统性自身免疫病,可以累及全身多个系统和脏器,尤其是呼吸系统,这也是影响这类患者预后的重要原因.PM/DM呼吸系统受累以吸入性肺炎和间质性肺病最为常见,肺动脉高压也不少见,自发性纵隔/皮下气肿是一罕见的危重并发症.吸入性肺炎明显增加了这类患者的死亡率,一旦发生,停止经口进食水,及时给予合适的抗生素.出现关节痛或关节炎和指/趾端毛细血管环扩大、抗JO-1抗体阳性的PM/DM患者,容易合并间质性肺病(ILD).ILD可发生于PM/DM病程的任何阶段,临床表现上与其他肺间质病变相似,可分为急性或亚急性间质性肺炎型、缓慢进展型和无症状型三个亚型,主要采用糖皮质激素或激素联合免疫抑制剂治疗.本文就PM/DM的呼吸系统并发症作一综述.     

皮肌炎/多发性肌炎死亡危险因素分析

目的 回顾性总结皮肌炎（DM）或多发性肌炎（PM）患者的临床特征,分析DM/PM死亡的独立危险因素。方法 回顾性分析2016年1月~2019年9月在河北医科大学第二医院初次就诊并符合2004年国际肌病协作组建议的特发性炎症性肌病（IIM）分类诊断标准的212例DM/PM患者的临床资料, 根据半年内是否死亡分为研究组（死亡组）和对照组（非死亡组）,分析两组临床特点及实验室检查的差异,总结DM/PM死亡的独立危险因素。结果 两组间男性、白蛋白（ALB）<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病差异有统计学意义（P<0.05）;Logistic回归分析ALB<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病与DM/PM死亡密切相关（P<0.05）。结论 男性、ALB<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病为DM/PM死亡的独立危险因素,提示预后不良。     

83例多发性肌炎/皮肌炎伴呼吸系统损害的观察与护理

目的探讨多发性肌炎/皮肌炎伴呼吸系统损害患者的临床护理策略。方法选择83例多发性肌炎/皮肌炎伴呼吸系统损害患者为研究对象,护理人员在治疗期间实施针对性护理方法,观察护理效果。结果 83例患者中,除1例发生呼吸衰竭死亡,3例自主放弃治疗外,79例患者病情得到有效控制,好转出院,总有效率95.18%。结论多发性肌炎/皮肌炎伴呼吸系统损害患者治疗期间,护理人员根据具体症状进行原因分析,实施针对性护理措施,可提高提高疗效,改善疾病转归。     

皮肌炎/多发性肌炎合并ARDS患者临床特征分析

正特发性炎性肌病(idiopathic inflammatory myopathies,IIM)是一组病因未明的以四肢近端肌无力为主要表现的骨骼肌非化脓性炎症性疾病,临床以皮肌炎(dematomyositis,DM)、多发性肌炎(polymyositis,PM)多见,以肌肉和(或)皮肤损伤为主要特征。DM合并间质性肺病(interstitial lung     

Clinical value of YKL‐40 in patients with polymyositis/dermatomyositis: A cross‐sectional study and a systematic review

IntroductionWe performed a cross‐sectional study to investigate the clinical usefulness of YKL‐40 in patients with dermatomyositis (DM) and conducted a systematic review to summarize the clinical value of YKL‐40 in patients with polymyositis (PM)/DM.Materials and methodsA cross‐sectional study and a systematic review were performed to study the clinical value of YKL‐40 in patients with PM/DM. Serum YKL‐40 level was detected using enzyme‐linked immunosorbent assay, and its association with clinical and laboratory parameters was analyzed. In the systematic review, electronic databases of OVID Embase, OVID Medline, and web of science were searched to collect studies that reported clinical use of YKL‐40 in patients with PM/DM.ResultsIn the cross‐sectional study, serum YKL‐40 level was higher in patients with DM than in healthy controls (median [interquartile range]: 84.09 [52.72–176.4] ng/ml versus 27.37 [12.30–53.58] ng/ml, p < 0.0001). Serum levels of YKL‐40 were associated with the course of DM (r = −0.469, p < 0.001), CRP (r = 0.303, p = 0.043), CK (r = 0.263, p = 0.037), and global disease activity (r = 0.628, p < 0.001). The area under the ROC curve was 0.835 (95% confidence interval 0.751–0.920). In the systematic review, a total of four studies were included with moderate to high quality. Serum level of YKL‐40 has the possibility for diagnosing PM/DM, identifying PM/DM patients with interstitial lung disease (ILD) or rapid progress ILD, and predicting death.ConclusionSerum YKL‐40 level is a possible useful biomarker for PM/DM diagnosis and may be used to predict prognosis.     

Renal involvement in patients with polymyositis and dermatomyositis

Renal involvement in patients with polymyositis (PM)/dermatomyositis (DM) is previously thought to be uncommon, but two main types of renal lesion have been described. First, acute tubular necrosis with renal failure related to myoglobulinemia and myoglobulinuria is a well-recognised feature of acute rhabdomyolysis. Second, chronic glomerulonephritis has been infrequently reported in a small group of patients with PM/DM. This study aims at investigating the incidence, severity and prognosis of renal disease in PM/DM patients, admitted to a single centre in a 10-year interval. The hospital records of 65 Taiwanese patients with PM/DM, examined between 1992 and 2002, were studied retrospectively. Of the 65 patients, 14 were found to have suffered varying degree of renal involvement, and the incidence rate was 21.5%. All the 14 patients had varying degree of haematuria and proteinuria. Acute tubular necrosis with renal failure developed in four patients with PM and in five patients with DM. Renal biopsy in two DM patients with overt proteinuria revealed IgA nephropathy in one and membranous nephropathy in the other. We, therefore, concluded that renal involvement in PM/DM patients is not as uncommon as previously thought.     

血清肌酶在评价皮肌炎与多肌炎合并肺间质病变中的作用

目的比较皮肌炎/多肌炎(DM/PM)患者血清肌酶水平与肺间质病变(ILD)的相关性.方法采用回顾性分析方法,收集96例在我科住院的DM/PM患者,经临床症状、体征、胸片、肺高分辨率CT(HRCT)及肺功能检查将所有患者分为合并ILD组(37例)和不合并ILD组(59例),并对其中67例患者进行追踪观察.结果①入院初(肌炎活动期),根据患者在入院前是否使用糖皮质激素、细胞毒药物等免疫抑制剂的情况进行分组A.入院前未接受免疫抑制剂治疗的37例患者中11例合并ILD,其血清AST、LDH水平显著高于无ILD者(P＜0.05),而肌酸激酶(CK)差异无显著性(P＞0.05);B.入院前已接受免疫抑制剂治疗的59例患者中26例合并ILD,其血清AST、LDH水平亦显著高于无ILD者(P＜0.05),CK差异亦无显著性(P＞0.05).②对经治疗后肌炎恢复的67例患者追踪随访,其中25例合并ILD者的血清AST、LDH水平显著高于无ILD者(P＜0.05),而CK差异仍无显著性(P＞0.05).③观察比较上述67例患者血清肌酶治疗前后的差值变化与ILD的相关性,结果AST、CK、LDH治疗前后差值的变化在两组患者中差异无显著性(P＞0.05).结论①DM/PM患者在肌炎活动时血清AST、LDH水平与ILD具有相关性,合并ILD患者具有高水平的AST、LDH值,而CK与ILD无明显相关性;②DM/PM患者在接受糖皮质激素等治疗病情稳定后,合并ILD患者血清AST、LDH仍可维持较高水平;③DM/PM患者治疗前后血清肌酶差值的变化与ILD无明显相关性.     

皮肌炎或多发性肌炎合并间质性肺炎28例临床分析

【目的】研究皮肌炎或多发性肌炎(DM或PM)合并间质性肺炎(ILD)的临床特点。【方法】采用回顾性分析方法对2001年7月1日至2004年12月31日在本院住院的95例DM或PM患者进行分析,将患者按照合并及未合并ILD分成两组进行临床和实验室资料的分析比较。【结果】95例DM或PM患者中,合并ILD的有28例,ILD的发生率为29．5％。28例患者中好转22例(78．6％),恶化2例(7．1％)．死亡4例(14．3％)。关节炎或关节痛、ESR、CRP、AST、LDH等部分指标在两组间显示有统计学意义。【结论】ILD在DM或PM中发病率较高,DM或PM患者应进行常规肺部检查。关节炎、关节痛,ESR、CRP、LDH、AST的增高都是ILD发生的预示性指标。     

不同碘水平下甲状腺结节患者血清外泌体中miRNA生物学标志物的筛选*(1., b.流行病学教研室,济南250000;2.,山东成武274200;3.泰安市中心医院a.甲状腺外科, b.检验科,山东泰安271000;4.山东第一医科大学第二附属医院a.甲状腺外科,b.检验医学科,山东泰安271000)

摘要:目的比较不同碘水平下甲状腺结节患者与健康人血清外泌体微小核糖核酸( microRNA, miRNA)表达谱的差异,分析其共同点,为筛选不同碘水平下甲状腺结节早期诊断标志物提供参考依据。方法收集10例不同碘水平下甲状腺结节患者及体检健康者的外周血样本,采用砷饰催化分光光度法测定各组血清碘水平;提取外泌体miRNA,利用高通量测序技术测定血清miRNA的表达水平;预测差异靶基因,并进一步进行CO( Gene ontology)分析和KECG(Kyoto Encyclopedia of Genes andGenomes)分析。结果在不同碘水平的甲状腺结节患者与健康人群中存在6个表达下调的miRNA,分别为 miR-324-5p.miR-6511b-3p, miR-9903 ,miR-550a-3p、miR-50O1-3p、miR-3688-3p。差异表达的外泌体 miRNA可调控MAPK信号通路、PI3K-AKT信号通路、VEGF信号通路及NF-KB信号通路。结论筛选出6个差异表达miRNA,有望作为不同碘水平下甲状腺结节早期诊断的生物学标志物。     

Aerobic capacity in adult dermatomyositis/polymyositis patients and healthy controls

OBJECTIVE: Assessment of myositis patients has relied on symptoms, strength testing, and serum muscle enzyme activity. Recently, functional assessments and evaluation of strength by dynamometry and of disease activity by magnetic resonance imaging have also been added. Aerobic testing in selected patients has been considered useful. DESIGN: Case-control study. SETTING: University Hospital, Vienna, Austria. PATIENTS: Twenty-two subjects (8 outpatients with chronic dermatomyositis and 3 outpatients with chronic polymyositis, and 11 healthy controls) participated, allowing the identification of 11 case-control pairs matched by age (+/-3 years) and gender (mean age, 48+/-14 yrs; ratio of women to men, 18/4). MAIN OUTCOME MEASURES: Target parameters were peak oxygen uptake (peak VO2) to estimate aerobic exercise capacity and peak isometric torque for muscle strength. Creatine phosphokinase (CPK) was measured to assess elevation of muscle enzymes. RESULTS: The mean peak VO2 in patients with dermatomyositis/polymyositis was 15.3 mL/min/kg (SD = 5.8) and in the healthy controls 28.7 mL/min/kg (SD = 7.8). Cardiorespiratory capacity expressed as peak VO2 was thus significantly reduced at 53% (p = .0001) of the control value. Muscle strength expressed as peak isometric torque was significantly lower (p = .01) in patients (mean 148+/-73 Nm) when compared to the control group (mean 261+/-99 Nm). In myositis patients peak VO2 and peak isometric torque correlate well with each other (r = .7631; p = .0001), but not at all with serum CPK levels (r = .056; p = .869). CONCLUSION: Peak VO2 is significantly diminished in patients with dermatomyositis/polymyositis, compared with age- and sex-matched controls. Serum CPK did not significantly correlate with VO2. Aerobic exercise testing may be a useful assessment parameter in selected patients with dermatomyositis/ polymyositis.