Marie I, Hatron P Y, Levesque H, Hachulla E, Hellot M F, Michon-Pasturel U, Courtois H, Devulder B
Department of Internal Medicine, CHU Rouen-Boisguillaume, France.
Medicine (Baltimore). 1999 May;78(3):139-47. doi: 10.1097/00005792-199905000-00001.
In a retrospective study of 79 consecutive patients, we evaluated characteristics of polymyositis (PM) and dermatomyositis (DM) and compared clinical presentation, biochemical findings, histologic changes, evolution, complications, and mortality rate of elderly patients (aged > or = 65 yr) and younger patients (aged < or = 64 yr) at the onset of PM/DM. We found a high prevalence of PM/DM in elderly patients: 23 patients (29%) were aged 65 years or over. We also found that esophageal involvement (34.8% versus 16.1%, respectively) and bacterial pneumonia related to both ventilatory insufficiency and esophageal impairment (21.7% versus 5.4%, respectively) were more common in elderly patients compared with younger patients, resulting in increased morbidity and mortality rates. Moreover, malignancy frequency was higher in elderly patients compared with younger patients (47.8% versus 9.1%, respectively, p = 0.0001), particularly patients with DM (10/11). Fifty percent of malignancies were colon malignancies in elderly patients. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and ferritin levels were also higher in the elderly patient group compared with the younger group, and the presence of serum hypoprotidemia, hypoalbuminemia, and anemia was more frequent. Finally, PM/DM complete remission was less frequent (13.6% versus 41.1%) and the mortality rate (47.8% versus 7.3%) was higher in elderly patients than in younger patients. The main causes of death in elderly patients were bacterial pneumonia, due to ventilatory insufficiency and esophageal impairment, and malignancies. Our findings therefore indicate that PM/DM-related esophageal and lung involvement should be systematically searched for in elderly patients. Esophageal manometry and pulmonary function tests should become an integral part of initial evaluation in elderly patients for early detection of impairment. Moreover, as we observed a marked overrepresentation of colon cancer in elderly patients with DM, we suggest that the search for malignancies in elderly patients with DM should include lower gastrointestinal tract investigations.
在一项对79例连续患者的回顾性研究中，我们评估了多发性肌炎（PM）和皮肌炎（DM）的特征，并比较了老年患者（年龄≥65岁）和年轻患者（年龄≤64岁）在PM/DM发病时的临床表现、生化检查结果、组织学变化、病情演变、并发症及死亡率。我们发现老年患者中PM/DM的患病率较高：23例患者（29%）年龄在65岁及以上。我们还发现，与年轻患者相比，老年患者食管受累（分别为34.8%和16.1%）以及与通气功能不全和食管功能障碍相关的细菌性肺炎（分别为21.7%和5.4%）更为常见，导致发病率和死亡率增加。此外，老年患者的恶性肿瘤发生率高于年轻患者（分别为47.8%和9.1%，p = 0.0001），尤其是DM患者（10/11）。老年患者中50%的恶性肿瘤为结肠癌。老年患者组的红细胞沉降率、C反应蛋白、纤维蛋白原和铁蛋白水平也高于年轻组，血清蛋白减少、低白蛋白血症和贫血的发生率更高。最后，老年患者中PM/DM完全缓解的情况较少（13.6%对41.1%），死亡率（47.8%对7.3%）高于年轻患者。老年患者的主要死亡原因是由于通气功能不全和食管功能障碍导致的细菌性肺炎以及恶性肿瘤。因此，我们的研究结果表明，应系统地检查老年患者中与PM/DM相关的食管和肺部受累情况。食管测压和肺功能测试应成为老年患者初始评估的组成部分，以便早期发现功能障碍。此外，由于我们观察到老年DM患者中结肠癌的比例明显过高，我们建议对老年DM患者进行恶性肿瘤筛查时应包括下消化道检查。
