皮肌炎继发干燥综合征及横纹肌溶解症一例及文献复习

目的提高对皮肌炎继发干燥综合征及横纹肌溶解症的认识。方法报告1例临床罕见的皮肌炎继发干燥综合征及横纹肌溶解症病例并复习相关文献。结果患者为48岁女性,以皮疹、关节肿痛、四肢近端肌痛、肌无力为主要临床表现,肌酸激酶极度升高,血肌红蛋白、尿肌红蛋白明显高于正常,抗核抗体、抗SSA抗体、抗SSB抗体阳性,唾液流率、Schirmer试验异常,肌电图为肌源性损害。确诊为皮肌炎继发干燥综合征及横纹肌溶解症,经血液净化、激素、免疫抑制剂等治疗,肾功能保持在正常范围,临床症状改善,随诊半年血清肌酸激酶、血肌红蛋白、尿肌红蛋白等生化指标恢复正常。结论皮肌炎继发干燥综合征及横纹肌溶解症临床罕见,并且皮肌炎与横纹肌溶解症临床表现及部分实验室检查相似,容易把横纹肌溶解症与皮肌炎或多肌炎相混淆而漏诊;横纹肌溶解症合并多肌炎或皮肌炎时,容易出现急性肾功能衰竭,病情危重,临床上应予以重视。

A case report and literature review on dermatomyositis with Sjogren's syndrome and rhabdomyolysis

Objective To improve the understanding of dermatomyositis with Sjgren's syndrome and rhabdo-myolysis.Methods A case of dermatomyositis with Sjgren's syndrome and rhabdomyolysis was reported and the related literatures were reviewed.Result A 48-year-old woman presented clinically skin rash,swollen and tender joints,myasthenia weakness and pain in her limb proximal muscles.Antinuclear antibody,anti-SSA and anti-SSB were positive.Laboratory investigations showed increased blood creatinine kinase(CK),serum and urine myoglobin.Schirm-er's test and salivary flow rates showed abnormal.Electromyography(EMG)indicated myogenic lesion.She was there-fore diagnosed as dermatomyositis with Sjgren's syndrome and rhabdomyolysis.After haemodialysis and corticosteroids and immunosuppressant treatment,with renal function kept in a norm her condition gradually improved.Six months after her admission,CK and myoglobin resumed normal.Conclusion Dermatomyositis with Sjgren's syndrome and rhabdomyolysis is rare.Rhabdomyolysis and dermatomyositis or polymyositis have similar manifestations and laboratory abnormalities,thereby readily causing misdiagnosis or missed diagnosis of the disease.When complicated with dermato-myositis or polymyositis,rhabdomyolysis tends to induce acute renal failure and other critical conditions which justify clinical attention.