Chen Pan, Xie Jianping, Xiao Rong, Zhang Guiying, Qiu Xiangning, Zhan Yi
Department of Dermatology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2019 Oct 28;44(10):1157-1162. doi: 10.11817/j.issn.1672-7347.2019.180726.
To investigate the clinical characteristics of dermatomyositis, to investigate the types and clinical features of dermatomyositis complicated with malignant tumor, and to provide evidence for clinical diagnosis, treatment and prognostic evaluation. Methods: The clinical manifestations and laboratory test results for 108 cases of dermatomyositis with complications in the Second Xiangya Hospital of Central South University were analyzed. Results: Patients aged from 14 to 60 years accounted for 62.96%. The first symptom was single skin rash (54.63%), and the most characteristic cutaneous features were asymmetrical proximal myositis with various degrees (97.22%). The visceral involvement was as follows: the digestive tract (31.48%), the heart (19.44%), the lung (26.85%), and the thyroid damage (12.96%). Twelve (11.11%) patients were combined with malignant tumor. The positive rates for albumin (ALB), glutamic oxalacetic transaminase (AST), glutamic-pyruvic transaminase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), erythrocyte sedimentation rate (ESR), anti Jo-1 antibody, anti ribonucleoprotein (RNP) antibody, and anti-topoisomerasel (Scl) antibody were 25.93%, 46.30%, 28.70%, 87.04%%, 51.85%, 26.85%, 55.56%, 2.27%, 8.99%, and 2.27%, respectively. The patients were divided into a tumor group and a non-tumor group. The chi-square test results from clinical symptoms and laboratory tests suggested that increase of ESR was a risk factor for dermatomyositis combining tumor. The main strategy of therapy was corticosteroids. Conclusion: Dermatomyositis possesses typical skin lesions and dermatitis is the most common initial symptom of dermatomyositis. In clinic, diagnosis of dermatomyositis should be timely combined with muscle enzymes test, electromyography and muscle biopsy. Dermatomyositis can easily involve many organs. Thus relevant examinations (such as chest X-ray and CT) should be done preventively. Rapid ESR is a risk factor for dermatomyositis complicated with malignant tumor and it can be used as an index to guide clinical diagnosis.
探讨皮肌炎的临床特点,研究皮肌炎合并恶性肿瘤的类型及临床特征,为临床诊断、治疗及预后评估提供依据。方法:分析中南大学湘雅二医院108例合并症皮肌炎患者的临床表现及实验室检查结果。结果:年龄14~60岁患者占62.96%。首发症状以单纯皮疹为主(54.63%),最具特征性的皮肤表现为不同程度的不对称性近端肌无力(97.22%)。内脏受累情况如下:消化道(31.48%)、心脏(19.44%)、肺(26.85%)、甲状腺损害(12.96%)。12例(11.11%)患者合并恶性肿瘤。白蛋白(ALB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、红细胞沉降率(ESR)、抗Jo-1抗体、抗核糖核蛋白(RNP)抗体、抗拓扑异构酶1(Scl)抗体阳性率分别为25.93%、46.30%、28.70%、87.04%、51.85%、26.85%、55.56%、2.27%、8.99%、2.27%。将患者分为肿瘤组和非肿瘤组。临床症状及实验室检查的卡方检验结果提示,ESR升高是皮肌炎合并肿瘤的危险因素。主要治疗策略为糖皮质激素。结论:皮肌炎具有典型皮损,皮炎是皮肌炎最常见的首发症状。临床诊断皮肌炎应及时结合肌酶检测、肌电图及肌肉活检。皮肌炎易累及多器官,应预防性进行相关检查(如胸部X线及CT)。ESR增快是皮肌炎合并恶性肿瘤的危险因素,可作为指导临床诊断的指标。