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特发性炎性肌病 (一)PM和DM(续前) 诊断:当临床表现典型、血CK升高、EMG示多灶性肌病改变伴自发电位、肌活检存在坏死性炎性过程时,诊断不难。然而,临床表现不典型而酶水平正常或EMG和活检正常或非特异性改变时,以下基于某些主要临床和实验室标准的诊断系统是有用的:(1)主要或完全为肢体近端肌肉受累。通常为对称性,肌无力呈进行性,超过数周或数月;(2)有肌纤维坏死、再生和单核细胞浸润的活检证据;(3)血清CK(MM同功酶)、醛缩酶或肌球蛋白升高;(4)EMG有多灶性肌病改变。当以上4条均符合时可确诊;3条符合则很可能为PM或DM;如果存在第1条而又可排除其它肌病时则有理由进行治疗。虽CK变化与病程及病情活动性关系密切,但也有1/4病例CK正常。在大多数未
Idiopathic inflammatory myopathies PM and DM (cont.) Diagnosis: When the clinical manifestations, elevated blood CK, EMG showed multifocal myopathy changes with spontaneous potential, muscle biopsy necrotizing inflammatory process Diagnosis is not difficult. However, the following diagnostic systems based on some major clinical and laboratory criteria are useful when the clinical manifestations are not typical and the enzyme levels are normal or the EMG and biopsy are normal or nonspecific: (1) Main or complete proximal proximal muscle involvement . Usually symmetrical, muscle weakness was progressive, more than a few weeks or months; (2) there is muscle fiber necrosis, regeneration and mononuclear cell infiltration of biopsy evidence; (3) serum CK (MM isozymes), aldolase Or myosin; (4) EMG multifocal myopathy changes. When the above four are diagnosed correctly; three are likely to be PM or DM; if the existence of Article 1 and exclude other myopathy when there is reason to treat. Although CK changes and disease activity and disease activity is closely related, but there are 1/4 cases of CK normal. In most did not