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目的分析多发性肌炎(PM)的临床特点、治疗及预后。方法收集56例PM患者的临床资料,对其临床特点、实验室检查结果、治疗与预后进行回顾性分析。结果 56例患者的平均发病年龄(45±19)岁,男∶女为1∶1.9。以亚急性起病者居多,首发症状以四肢无力多见。叠加综合征患者血清中抗核抗体(ANA)、抗干燥综合征-A(SS-A)抗体、抗干燥综合征-B(SS-B)抗体的阳性率明显高于特发性PM患者(均P<0.05),抗Jo-1抗体在合并肺损害的PM患者中多见,92.9%的患者血清CK升高;11例行肌肉MRI,其中81.8%有异常信号;肌电图检查有肌源性损害占87.0%;肌肉病理检查85%呈肌源性损害。用糖皮质激素、免疫抑制剂、静脉丙种球蛋白和雷公藤多甙等药物联合治疗后,94.6%的患者预后良好。结论 PM多以亚急性起病为主,发病率女多于男,首发症状多为四肢无力。血清部分自身抗体可用于筛选伴叠加综合征的PM患者;抗Jo-1抗体阳性提示可能伴有肺部损害;血清肌酶增高,结合肌电图、肌肉MRI、肌肉活检等诊断技术可提高PM临床诊治水平。
Objective To analyze the clinical features, treatment and prognosis of polymyositis (PM). Methods The clinical data of 56 patients with PM were collected. The clinical features, laboratory findings, treatment and prognosis were retrospectively analyzed. Results The average age of onset of 56 patients (45 ± 19) years, male: female was 1: 1.9. Mostly subacute onset, the first symptom to extremities weakness more common. The positive rates of serum anti-nuclear antibody (ANA), anti-Sjogren’s syndrome-A (SS-A) antibody and anti-Sjogren’s syndrome-B antibody in superposition syndrome patients were significantly higher than those in idiopathic PM patients P <0.05). Anti-Jo-1 antibody was more common in PM patients with lung injury, and serum CK was higher in 92.9% of the patients. MRI was performed in 11 patients, of which 81.8% had abnormal signals. Electromyography showed muscle 87.0% of the origin of damage; muscle pathology 85% showed myogenic damage. With glucocorticoids, immunosuppressive agents, intravenous gamma globulin and tripterygium glycosides and other drugs combined treatment, 94.6% of patients with good prognosis. Conclusions Most of the patients with subacute onset of PM, the incidence of more women than men, mostly the first symptom of limb weakness. Serum autoantibodies can be used to screen patients with superposition syndrome of PM; positive anti-Jo-1 antibody may be associated with lung damage; serum creatinine increased, combined with EMG, muscle MRI, muscle biopsy and other diagnostic techniques can improve PM clinical Diagnosis and treatment level.