Isoniazid-induced rhabdomyolysis in a patient with chronic heart failure: a case report

Rhabdomyolysis is one of the identified uncommon .but potentially lethal complications of isoniazidintoxication, which can be secondary to severe muscle exertion due to generalized seizures or can be caused by direct toxicity of either the drug or one of its metabolites on muscles.1＇2 ^However, as widely used anti-tuberculosis drug in China, isoniazid induced rhabdomyolysis appears to be very rare. To our knowledge, there is no report indicating association between rhabdomyolysis and isoniazid intoxication in Chinese population. We presented herein a case report of isoniazid-induced rhabdomyolysis in a Chinese man with chronic heart failure.     

糖尿病患者应用他汀药物致肌病8例报告

目的 分析糖尿病患者应用他汀药物出现肌病的临床特点及发生原因. 方法 回顾性分析8例糖尿病患者应用他汀类药物致肌病的临床资料,并进行相关文献复习. 结果 8例患者均有肌肉酸痛,其中5例肌酸激酶(CK)升高.2例诊断为横纹肌溶解症,3例为肌炎,3例为较轻肌痛.引起肌病的药物主要为辛伐他汀、阿托伐他汀,1例为阿托伐他汀联用非诺贝特引起横纹肌溶解症,1例为氟伐他汀引起肌痛.2例横纹肌溶解病人合并多种疾病及多种合并用药. 结论 糖尿病患者尤其合并多种基础疾病及合并用药多的患者在应用他汀类药物时要严密观察临床症状及生化指标检测.     

糖尿病患者应用他汀药物致肌病8例报告

目的：分析糖尿病患者应用他汀药物出现肌病的临床特点及发生原因。方法回顾性分析8例糖尿病患者应用他汀类药物致肌病的临床资料,并进行相关文献复习。结果8例患者均有肌肉酸痛,其中5例肌酸激酶( CK)升高。2例诊断为横纹肌溶解症,3例为肌炎,3例为较轻肌痛。引起肌病的药物主要为辛伐他汀、阿托伐他汀,1例为阿托伐他汀联用非诺贝特引起横纹肌溶解症,1例为氟伐他汀引起肌痛。2例横纹肌溶解病人合并多种疾病及多种合并用药。结论糖尿病患者尤其合并多种基础疾病及合并用药多的患者在应用他汀类药物时要严密观察临床症状及生化指标检测。     

Acute myoedema: an unusual presenting manifestation of hypothyroid myopathy

We describe a patient with primary hypothyroidism due to autoimmune thyroiditis, presenting with acute myoedema and spontaneous rhabdomyolysis. During his hospital stay, he developed altered sensorium due to hypo-osmolal hyponatraemia and later developed bilateral foot drop that responded to appropriate treatment.     

Nivolumab致甲状腺功能减退症1例

Nivolumab是一种抗PD-1单克隆抗体，用于肿瘤免疫治疗。中南大学湘雅三医院内分泌科收治1例肠癌术后 3年的73岁女性患者，用nivolumab治疗后引起严重甲状腺功能减退症。患者接受nivolumab治疗4个月后出现乏力、头 晕、皮肤变黄及眼睑浮肿等症状，FT3和FT4减低，TSH升高，随后终止nivolumab治疗，用左甲状腺素钠片替代治疗后 患者症状缓解，甲状腺功能恢复正常。临床诊断为nivolumab诱导自身免疫甲状腺损害，为治疗中免疫相关不良反应。     

皮肌炎重叠系统性硬化症合并横纹肌溶解症1例并文献复习

目的:提高对重叠综合症继发横纹肌溶解症的认识。方法:报告1例罕见的重叠综合症患者继发横纹肌溶解症病例,并复习相关文献。结果:患者为43岁女性,以皮疹、肌无力2年半,肢端遇冷变色伴皮肤紧硬1年半为主要临床表现,肌酸激酶极度升高,血肌红蛋白、尿肌红蛋白明显高于正常,考虑重叠综合征继发横纹肌溶解症,经血液净化、免疫抑制等治疗临床症状及实验室指标改善。结论:重叠综合征继发横纹肌溶解症临床罕见,当出现急性肾功能衰竭时,与系统性硬化症出现急性肾危象不易鉴别,容易漏诊。     

Clinical characteristics of spinning-induced rhabdomyolysis and other causes of rhabdomyolysis: a comparative study

Introduction:Spinning is an indoor stationary cycling programme that can cause severe rhabdomyolysis. We compared the clinical characteristics of spinning-induced exertional rhabdomyolysis (SER) with other exertional rhabdomyolysis (ER) and non-exertional rhabdomyolysis (NER).Methods:This was a retrospective observational study of adult patients presenting with rhabdomyolysis to an emergency department from August 2018 to August 2019. Patients were classified as SER, ER or NER based on chart review. We compared patient demographics, serum creatine kinase (CK), transaminase and creatinine levels, admission rates, duration of hospitalisation and treatment prescribed.Results:62 patients were analysed. SER patients were predominantly female (77% vs. 24% vs. 26%, P < 0.01), Chinese (100% vs. 47% vs. 79%, P < 0.01) and younger (mean age 27.7 vs. 34.6 vs. 59.4 years, P < 0.01) than those with ER and NER. The SER group had the highest CK level (20,000 vs. 10,465 vs. 6,007 U/L, P < 0.01) but the lowest mean serum creatinine level (53.5 vs. 80.9 vs. 143.5 μmol/L, P < 0.01) compared to the ER and NER groups. Admission rates were the highest in SER patients (100% vs. 57% vs. 90%, P < 0.01). SER mean inpatient length of stay was longer than ER but shorter than NER patients (4.3 vs. 1.9 vs. 6.0 days, P = 0.02).Conclusion:SER is a unique form of rhabdomyolysis. Predominantly seen in young, healthy women, it often presents with extremely high CK levels. However, the prognosis is good and the rate of complication is low with fluid treatment.     

线粒体脑肌病合并脂质沉积性肌病1例报告并文献复习

目的 探讨线粒体脑肌病和肉毒碱缺乏的关系.方法 报道1例合并脂质沉积性肌病的线粒体脑肌病患者的临床和病理特点,并复习相关文献.结果 患者主要表现为癫痫大发作和四肢无力,激素治疗效果好.肌肉病理改变特点是许多肌纤维内可见细小空泡,被脂滴填充和较多不典型破碎红纤维(RRF).电镜下见大量脂肪滴,呈串珠样和片状分布;并出现线粒体增多和结构异常,可见嗜锇小体的形成.结论 此患者可以诊断为线粒体脑肌病合并脂质沉积性肌病,其发病机制可能是线粒体呼吸链的氧化缺陷使脂酰辅酶A过度聚集,导致继发性肉毒碱的缺陷.     

Primary hypothyroidism masquerading as hepatic encephalopathy: case report and review of the literature

A 74 year old woman with hepatitis C of long duration was admitted to hospital in hyperammonaemic coma. Despite aggressive treatment of hepatic encephalopathy, there was no clinical improvement. As part of her evaluation for other causes of altered mental status, she was found to be profoundly hypothyroid. Treatment with thyroid replacement hormone was accompanied by prompt normalisation of her mental status and hyperammonaemia. Hypothyroidism may exacerbate hyperammonaemia and portosystemic encephalopathy in patients with otherwise well compensated liver disease. Hyopthyroidism should be considered in the differential diagnosis of encephalopathy in patients with liver disease.     

舒必利导致横纹肌溶解症并急性肾功能衰竭1例

横纹肌溶解症是指可逆或不可逆的横纹肌细胞受损后使细胞膜的完整性改变,细胞内物质(如蛋白、离子、酶等)释放入血,最后从尿中排出.其主要临床特征为血清磷酸肌酸激酶升高,血和尿中的肌红蛋白阳性,伴肌痛、肌紧张和肌肉注水感.并且它可导致急性肾衰竭、电解质紊乱等一系列并发症,其病因包括肌肉损伤、药物过量中毒等.现将我院发生的1例舒必利导致横纹肌溶解症并急性肾功能衰竭病例报告如下.     

Acute rhabdomyolysis associated with cocaine intoxication: a case report

Over thirty million Americans are estimated to have tried cocaine at least once and 5 million use it on a regular basis. Recent media attention to the widespread use of cocaine has revealed the growing life-threatening complications that accompany its use. The effects of cocaine on the cardiovascular, pulmonary and central nervous system have been well-described in medical literature, but the complications of acute renal failure secondary to cocaine-induced rhabdomyolysis only recently have been addressed. Presented in this article is a case involving cocaine-induced acute renal failure.     

病毒性脑炎合并横纹肌溶解症的总结分析

目的探讨病毒性脑炎患儿在疾病急性期合并横纹肌溶解症（rhabdomyolysis,RM）的发病情况、治疗效果及预后,以提高其诊治水平。方法总结分析我院2009年1月~2011年12月期间诊治的病毒性脑炎患儿,合并横纹肌溶解症的发病率、临床治疗及预后。结果 120例病毒性脑炎患儿有9例合并横纹肌溶解症,主要表现为急性尿色改变,典型者呈红褐色,实验室检查提示血清肌酸激酶显著升高,血清肌红蛋白升高,尿肌红蛋白阳性。经过水化、碱化、利尿等对症、支持治疗,所有患儿临床症状均好转,复查血清肌红蛋白下降,尿肌红蛋白阴性。结论病毒性脑炎患儿病程中可以合并横纹肌溶解症且并不罕见,在临床上应引起高度重视。     

Coronary artery bypass grafting in a patient with history of esophagectomy, hypothyroidism, hypertension and type 2 diabetes mellitus: a case report

Coronary artery bypass grafting (CABG) is a mature procedure in treating patients with coronaty artery diseases. We report a patient undergoing CABG had history of esophageal cancer and multiple underlying diseases: hypothyroidism, type 2 diabetes mellitus and hypertension. A CABG with midline sternotomy was safely performed in the presence of thyroid replacement therapy and intensive control of blood pressure and blood glucose. The patient recovered postoperatively with supportive care. coronary artery bypass grafting; esophagectomy; hypothyroidism; type 2 diabetic mellitus

     

25例横纹肌溶解症的临床特点分析

目的:了解横纹肌溶解症的临床发病特点以及预后。方法:总结分析25例横纹肌溶解症的临床资料及治疗预后情况。结果:发病人群以青年男性为主,尤其是运动性横纹肌溶解症的患者;运动、热射病、挤压、药物、自身免疫性疾病等均可导致横纹肌溶解,本组病例运动性横纹肌溶解症占48.0%;起病急,病程短;均有血肌酸激酶增高,平均值为38 642U.L-1;多数病例伴急性肾衰竭(72.0%);88.0%的患者好转或痊愈,肾功能恢复正常或发病前水平,12.0%的患者死亡,死亡病例肌酸激酶显著高于好转病例。结论:横纹肌溶解症是一种可由运动等多种原因所致的急性疾病,均有肌酸激酶增高,常合并急性肾衰竭。及时诊治大多数可好转或痊愈,少数病情严重者预后差。     

围绝经期甲状腺功能减退症患者焦虑及抑郁情绪的临床研究

目的 以甲状腺功能减退症的围绝经期女性为研究对象,探讨甲状腺激素水平与这类人群焦虑和抑郁情绪的关系.方法 采用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)对甲状腺功能正常(对照组,n =33)、亚临床甲状腺功能减退症(亚临床甲减组,n=35)和临床甲状腺功能减退症(临床甲减组,n=78)的围绝经期女性进行评分,评估患者焦虑和抑郁的发生率以及评分与甲状腺激素的相关性.结果 临床甲减组SAS标准分较对照组升高(P＜0.05),亚临床甲减组SAS标准分对照组比较未见明显差异(P＞0.05);临床甲减组SDS标准分较其他两组均升高(P＜0.05),亚临床甲减组SDS标准分较对照组升高(P＜0.05).以中国人群常模为界值,各组SAS和SDS评分超过常模的发生率均有显著性差异(P＜0.05),其中临床甲减组SAS和SDS评分超过常模的发生率显著高于其余两组(P＜0.05),亚临床甲减组显著高于对照组(P＜0.05).SAS评分与游离甲状腺素(FT4)和促甲状腺激素(TSH)水平分别呈显著负相关(r=-0.326,P＜0.01)和正相关(r=0.240,P＜0.01);SDS评分三碘甲状腺原氨酸(FT3)、FT4均呈显著负相关(r=-0.427,r=-0.627,P＜0.01),与TSH呈显著正相关关系(r=0.555,P＜0.01).结论 围绝经期甲状腺功能减退症女性更易出现抑郁和焦虑,该时期患者抑郁和焦虑的程度与甲状腺激素水平相关.     

Vindesine induces rhabdomyolysis in patients with acute lymphoblastic leukemia

Rhabdomyolysis is a syndrome which involves myoglobin and other intracellular proteins and electrolytes that occurs from breakdown of skeletal muscleand leak into the circulation. The clinical symptoms of rhabdomyolysis include myalgia, tenderness on palpation, weakness, brown urine, fever, myoglobinuria, electrolyte imbalance, and acute renal failure. Rhabdomyolysis can be severe enough to be life threatening. The causes of rhabdomyolysis include alcohol, electrolyte imbalance （potassium, phosphorus, and magnesium depletion）, viral myositis, trauma, connective tissue diseases, drug reaction, toxication, exercise, metabolic diseases, seizures, and hereditary enzyme deficiencies. The exact mechanisms underlying rhabdomyolysis are not fully understood, but it is clear that muscle damage can be caused by direct muscle injury or metabolic inequalities between energy production and energy consumption.     

甲状腺功能减退症及亚临床甲状腺功能减退症患者的血脂变化研究

目的：观察甲状腺功能减退症（甲减）及亚临床甲状腺功能减退症（亚甲减）患者血脂的状况,并分析亚甲减患者促甲状腺素（ TSH）值与血脂间的关系。方法收集2011年1月至2014年6月在我院内分泌科门诊及病房就诊的甲减患者（甲减组）133例、亚临床甲减患者（亚甲减组）146例,并收集同期在我科门诊或病房检查甲状腺功能正常者86例作为对照组,比较各组血脂的变化;将亚甲减组按TSH 分层分为亚甲减-1组、亚甲减-2组,并与对照组比较。结果甲减组总胆固醇（ CHO）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ LDL-C）高于对照组,高密度脂蛋白胆固醇（ HDL-C）低于对照组,差异均有统计学意义（P＜0．05）;亚甲减组CHO、LDL-C均明显高于对照组,差异有统计学意义（P＜0．05）;分层后,亚甲减-1组CHO与对照组比较有升高趋势,但差异无统计学意义（P＞0．05）,TSH＞10μU／L亚甲减组CHO、TG、LDL-C均明显高于对照组,差异有统计学意义（P＜0．05）。结论甲减及亚甲减患者血脂明显升高,且亚甲减-2组患者血脂升高与TSH值升高有关,临床应予重视。     

Delayed onset of nemaline myopathy： a case report

Nemaline myopathy (NM), first reported by Shy et al^1 in 1963, is characterized by the presence of nemaline rods in myofibers and in the nucleus in severe cases. NM is a clinically rare, heterogeneous congenital muscle disorder, displaying dominant or recessive autosomal forms, and in rare cases, sporadic as well. Its chief     

妊娠合并甲状腺功能减低29例临床分析

目的 探讨妊娠期甲状腺功能减低的治疗时机及对围生结局的影响.方法 回顾性分析2000年10月至2010年10月于本院就诊的29例妊娠合并甲状腺功能减低患者的临床资料,根据其孕前是否开始治疗分为两组,比较两组妊娠结局及TSH、FT4在妊娠期的变化.结果 妊娠合并甲状腺功能减低症占本院住院分娩数的1.05%(29/27 685),尽管两组用药后甲状腺功能均得到改善,但妊娠前开始治疗的患者流产、早产及妊娠期糖尿病的发生率均较低,且新生儿Apgar评分较高,两组差异有统计学意义.结论 甲状腺功能减低症应及时治疗,改善甲状腺功能减低后再妊娠对母儿均有利.