甲减性类多肌炎样综合征与特发性炎性肌病合并甲状腺功能减退症鉴别

目的探讨甲减性类多肌炎样综合征与多发性肌炎或结缔组织病伴肌病间的异同点,从而减少误诊、漏诊。方法分析6例甲减性类多肌炎样综合征与4例甲状腺功能减退症伴多发性肌炎或结缔组织病伴肌病患者的临床资料以寻找规律并复习相关文献。结果甲减性类多肌炎样综合征与特发性炎性肌病在肌肉方面的表现相似,均有肌痛、肌无力、肌酶升高,但甲状腺功能、自身抗体、肌电图及肌肉病理多有不同,治疗方法迥异。急性炎症指标鉴别价值不大。结论对于肌肉无力和肌酶升高的患者需常规检测甲状腺功能。甲状腺功能及肌肉病理对鉴别甲减性类多肌炎样综合征和特发性炎性肌病所致肌肉病变至关重要。

Differential diagnosis of polymyositis-like syndrome in hypothyroidism and idiopathic inflammatory myositis associated with hypothyroidism and review of literature

Objective To determine the similarities and differencies between polymyositis-like syndrome in hypothyroidism and polymyositis or myopathy associated with connective tissue disease,in order to decrease omitted or misdiagnosis. Methods The clinical data of 6 patients with polymyositis-like syndrome in hypothyroidism and 4 patents with hypothyroidism accompanied by polymyositis or myopathy associated with connective tissue disease were analyzed to seek the rules and the relevant literature was reviewed. Results Polymyositis-like syndrome in hypothyroidism and idiopathic inflammatory myositis had similar symptoms of muscle dysfunction, for instance, myalgia, muscle weakness and elevation of serum muscle enzymes. But they could be distinguished by differences in thyroid function tests,types of autoantibodies, electromyogram and muscle pathology, particularly in therapy methods. The differential value of levels of acute inflammation indexes has no significance. Conclusion Thyroid function tests should be routinely performed in all patients with muscle weakness or elevations of muscle enzymes. Thyroid function tests and muscle pathology are specially important in the differential diagnosis between polymyositis-like syndrome in hypothyroidism and idiopathic inflammatory myositis.