类固醇肌病的临床和病理特点分析（附10例报道）

目的：探讨类固醇肌病的临床和病理特点。方法：收集2007至2011年收治的10例有使用糖皮质激素史,并经肌肉活检病理证实的类固醇肌病患者的临床资料,分析并总结其临床和病理特点。结果：10例类固醇肌病患者中女性6例、男性4例,年龄14~79（51.1±18.5）岁。使用激素后至起病时间为7 d至14个月。所有病例均表现为四肢近端无力,股四头肌均呈不同程度萎缩,7例以双下肢近端受累为主,3例同时有上臂肌群萎缩;血清肌酸激酶（CK）和CK-mb均正常,9例乳酸脱氢酶（LDH）值高于正常上限;肌电图示轻度肌源性损害;肌肉活检均可见肌纤维大小不一;酶学染色提示：Ⅱ型纤维选择性萎缩。结论：类固醇肌病好发于中老年人群,多在使用糖皮质激素数周至数月后发生,肌无力和肌萎缩以下肢近端为主,血清CK基本正常,LDH轻度增高,肌肉病理示选择性Ⅱ型纤维萎缩为其病理特点。

Clinical and Pathological Characteristics of Steroid Myopathy

Aim： To explore the clinical and pathological features of steroid myopathy.Methods： 10 patients with steroid myopathy pathologically defined by our hospital from 2007 to 2011 were analyzed.Results： Among the 10 patients,6 females and 4 males,aged from 14 to 79（51.1 ±18.5） years old,the onset occurs 7 days to 14 months after steroid therapy.The manifestations were proximal weakness of bilateral extremities with prominent quadriceps femoris atrophy.Serum creatine kinase（CK） and CK-mb were normal,but lactate dehydrogenase（LDH） increased in 9 cases.Electrophysiological study showed slight myopathic changes and pathological study showed variable muscle fibers.However,the selective type Ⅱ fiber atrophy is the characteristic feature of steroid myopathy.Conclusion： Elderly people are prone to have steroid myopathy and the symptom occurs several weeks or months after steroid administration.Weakness and atrophy mainly involve the proximal part of lower limbs.The serum CK is always normal,but the LDH commonly increased.Selective type Ⅱ fiber atrophy is the pathological feature.