108例皮肌炎临床分析

目的：探讨皮肌炎的临床特点,了解皮肌炎合并恶性肿瘤的类型及临床特征,以利于临床诊断、治疗及预后判断。方法：对108例皮肌炎患者及其中合并恶性肿瘤的12例患者的临床表现及实验室检查结果进行回顾性分析。结果：患者发病年龄以14~60岁(62.96%)为主;首发症状以皮炎(54.63%)为主;皮肤损害以面部红斑合并全身多处红斑多见(48.15%);肌肉受累以不同程度的对称性近端肌炎多见(97.22%)。受累内脏为消化道(31.48%)、心(19.44%)、肺(26.85%)、甲状腺(12.96%)。12例(11.11%)患者合并恶性肿瘤。白蛋白(albumin,ALB)、谷草转氨酶(glutamicoxalacetic transaminase,AST)、谷丙转氨酶(glutamic-pyruvic transaminase,ALT)、乳酸脱氢酶(lactic dehydrogenase,LDH)、血清肌酸激酶(creatine kinase,CK)、血清肌酸激酶同工酶(creatine kinase isozyme,CK-Mb)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、抗Jo-1抗体、抗核糖核蛋白(ribonucleoprotein,RNP)抗体、抗DNA拓扑异构酶抗体(anti-topoisomerase antibody,抗Scl抗体)阳性率分别为25.93%,46.30%,28.70%,87.04%,51.85%,26.85%,55.56%,2.27%,8.99%,2.27%。将患者分成合并肿瘤组和不合并肿瘤组,经χ2检验提示ESR异常增快是皮肌炎合并肿瘤的危险因素。治疗以糖皮质激素为主。结论：皮肌炎有典型的皮损表现,最常见的首发症状是皮炎。临床确诊应结合肌酶、肌电图、肌活检等相关检查。皮肌炎易累及多种器官,应预防性地行胸部X线及CT等相关检查。红细胞沉降率增快是皮肌炎合并恶性肿瘤的危险因素,可作为参考指标指导临床及时行相关检查以明确诊断。

Clinical analysis for 108 cases of dermatomyositis

Objective: To investigate the clinical characteristics of dermatomyositis, to investigate the typesand clinical features of dermatomyositis complicated with malignant tumor, and to provideevidence for clinical diagnosis, treatment and prognostic evaluation.Methods: Th e clinical manifestations and laboratory test results for 108 cases of dermatomyositiswith complications in the Second Xiangya Hospital of Central South University were analyzed.Results: Patients aged from 14 to 60 years accounted for 62.96%. The first symptom was singleskin rash (54.63%), and the most characteristic cutaneous features were asymmetrical proximalmyositis with various degrees (97.22%). The visceral involvement was as follows: the digestivetract (31.48%), the heart (19.44%), the lung (26.85%), and the thyroid damage (12.96%).Twelve (11.11%) patients were combined with malignant tumor. The positive rates for albumin(ALB), glutamic oxalacetic transaminase (AST), glutamic-pyruvic transaminase (ALT), lactatedehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), erythrocytesedimentation rate (ESR), anti Jo-1 antibody, anti ribonucleoprotein (RNP) antibody, and antitopoisomerasel(Scl) antibody were 25.93%, 46.30%, 28.70%, 87.04%%, 51.85%, 26.85%, 55.56%,2.27%, 8.99%, and 2.27%, respectively. The patients were divided into a tumor group and a nontumorgroup. The chi-square test results from clinical symptoms and laboratory tests suggestedthat increase of ESR was a risk factor for dermatomyositis combining tumor. The main strategy oftherapy was corticosteroids.Conclusion: Dermatomyositis possesses typical skin lesions and dermatitis is the most commoninitial symptom of dermatomyositis. In clinic, diagnosis of dermatomyositis should be timelycombined with muscle enzymes test, electromyography and muscle biopsy. Dermatomyositis caneasily involve many organs. Thus relevant examinations (such as chest X-ray and CT) should bedone preventively. Rapid ESR is a risk factor for dermatomyositis complicated with malignanttumor and it can be used as an index to guide clinical diagnosis.