Te Riele M G E, Schreuder T H A, van Alfen N, Bergman M, Pillen S, Smits B W, van der Wilt G J, Groenewoud H, Voermans N C, van Engelen B G M
Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Neuromuscul Disord. 2017 Mar;27(3):243-250. doi: 10.1016/j.nmd.2016.12.002. Epub 2016 Dec 15.
Myalgia, fatigue, and exercise intolerance are cause for referral to a neurologist. However, the diagnostic value of history, neurological examination, and ancillary investigations in patients with these symptoms is unknown. This study provides a sound footing for deciding which ancillary investigations should be conducted. A prospective observational study of the diagnostic approach in 187 patients with myalgia, exercise intolerance, or fatigue as their predominant symptom was performed. The primary outcomes were independent contribution of referral letter, history, examination, and ancillary investigations to a myopathy diagnosis. The secondary outcome was diagnostic value of combined ancillary investigations. 27% of patients had a myopathy. Positive family history (OR 3.2), progressive symptoms (OR 2.2), atrophy (OR 9.7), weakness (OR 10.9), and hyporeflexia (OR 4.4) were associated with a myopathy. Positive predictive values for myopathy were calculated for CK (0.32), EMG (0.66), ultrasound (0.47), and muscle biopsy (0.78). All contributed significantly in predicting myopathy. Multivariate analysis yielded a diagnostic algorithm facilitating a more efficient work-up in future patients. CK levels, EMG, ultrasound, and muscle biopsy independently contribute to predicting a myopathy. The diagnostic algorithm shows which combination of ancillary investigations should be employed in different subgroups and when to omit invasive techniques. This algorithm may drastically improve diagnostic efficiency.
肌痛、疲劳和运动不耐受是转诊至神经科医生的指征。然而，对于有这些症状的患者，病史、神经学检查及辅助检查的诊断价值尚不清楚。本研究为决定应进行哪些辅助检查提供了坚实基础。对187例以肌痛、运动不耐受或疲劳为主要症状的患者的诊断方法进行了一项前瞻性观察研究。主要结局是转诊信、病史、检查及辅助检查对肌病诊断的独立贡献。次要结局是联合辅助检查的诊断价值。27%的患者患有肌病。阳性家族史（比值比3.2）、进行性症状（比值比2.2）、萎缩（比值比9.7）、肌无力（比值比10.9）和反射减弱（比值比4.4）与肌病相关。计算了肌酸激酶（CK）、肌电图（EMG）、超声和肌肉活检对肌病的阳性预测值（分别为0.32、0.66、0.47和0.78）。所有这些检查在预测肌病方面均有显著贡献。多变量分析得出了一种诊断算法，有助于未来患者进行更有效的检查。CK水平、EMG、超声和肌肉活检在预测肌病方面具有独立作用。该诊断算法显示了在不同亚组中应采用哪些辅助检查组合以及何时省略侵入性技术。这种算法可能会大幅提高诊断效率。
