Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
School of Medicine, Nankai University, Tianjin, China.
Front Immunol. 2023 Feb 28;14:1094611. doi: 10.3389/fimmu.2023.1094611. eCollection 2023.
To investigate the characteristics of cardiac involvement due to Immune-mediated Necrotizing Myopathy (IMNM).
Patients diagnosed with Immune-mediated Necrotizing Myopathy (IMNM) who attended the Department of Neurology and the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital between February 2011 and June 2022 were collected. Clinicopathological diagnosis of IMNM was performed according to the criteria established by the European Neuromuscular Center (ENMC). All patients underwent muscle biopsy and Myositis-specific antibodies (MSAs) testing. Information included age, gender, disease duration, intramuscular and extramuscular manifestations, laboratory findings (including creatine kinase, lactate dehydrogenase levels, troponin T, myoglobin and atrial natriuretic peptide), electromyography, skeletal muscle pathology and immunohistochemical staining.
A total of 57 patients were included in this study. Of the serological tests, 56.1% (32/57) were positive for SRP, 21.1% (12/57) were positive for HMGCR and 22.8% (13/57) were seronegative. Thirty patients (52.6%, 30/57) presented with varying degrees of cardiac involvement. We performed ECG in 23 patients and found 6 patients with arrhythmia (26.1%), 12 patients with myocardial ischemia (52.2%), and 7 patients with acute coronary syndrome (ST elevation and non-ST elevation myocardial infarction) (30.4%), and 4 patients with left axis deviation or left ventricular high voltage, suggesting left ventricular hypertrophy (17.4%). Cardiac ultrasound was performed in 14 patients and 3 showed pericardial effusion (21.4%); Decreased left ventricular ejection fraction and atrial enlargement were 2 each; 8 showed a decrease in left ventricular diastolic function (57.1%). In addition, one patient had myocardial edema.
Cardiac involvement is not uncommon in IMNM. However, besides clearly statistically significant differences in the disease course, and in the values of troponin T and myoglobin, our data did not show any statistically significant difference in other features of cardiac involvement between patients with different subtypes of IMNM.
研究免疫介导性坏死性肌病（IMNM）导致的心脏受累的特征。
收集 2011 年 2 月至 2022 年 6 月期间在解放军总医院神经内科和风湿免疫科就诊的免疫介导性坏死性肌病（IMNM）患者。根据欧洲神经肌肉中心（ENMC）制定的标准进行 IMNM 的临床病理诊断。所有患者均接受肌肉活检和肌炎特异性抗体（MSAs）检测。信息包括年龄、性别、疾病持续时间、肌内和肌外表现、实验室检查（包括肌酸激酶、乳酸脱氢酶水平、肌钙蛋白 T、肌红蛋白和心房利钠肽）、肌电图、骨骼肌病理和免疫组织化学染色。
本研究共纳入 57 例患者。在血清学检查中，56.1%（32/57）抗信号识别颗粒（SRP）阳性，21.1%（12/57）抗 3-羟基-3-甲基戊二酰辅酶 A 还原酶（HMGCR）阳性，22.8%（13/57）抗体阴性。30 例（52.6%，30/57）患者有不同程度的心脏受累。我们对 23 例患者进行了心电图检查，发现 6 例心律失常（26.1%），12 例心肌缺血（52.2%），7 例急性冠状动脉综合征（ST 段抬高和非 ST 段抬高心肌梗死）（30.4%），4 例左轴偏或左心室高电压，提示左心室肥厚（17.4%）。我们对 14 例患者进行了心脏超声检查，发现 3 例有心包积液（21.4%）；左心室射血分数降低和心房扩大各 2 例；8 例左心室舒张功能下降（57.1%）。此外，1 例患者有心肌水肿。
IMNM 心脏受累并不少见。然而，除了疾病过程、肌钙蛋白 T 和肌红蛋白值有明显统计学差异外，我们的数据并未显示不同亚型 IMNM 患者的心脏受累其他特征有任何统计学差异。
