Fernández-Fúnez A, de Tomás E, Alamillo A, Puras A
Servicio de Medicina Interna, Hospital General de Albacete.
Med Clin (Barc). 1995 Oct 7;105(11):412-5.
The aim of this study was to determine the causes of non traumatic or medical rhabdomyolysis (RM) and analyze the clinical and biologic characteristics, as well as the predictive factors of acute renal failure (ARF).
Fifty-nine patients with RM admitted to the Internal Medicine Department over an 18-month period were prospectively studied. The patients were classified into etiologic groups. Anamnesis, physical exploration and general analytical studies including creatinkinase, myoglobin, aldolase, magnesium and proteinogram were performed. Urine sodium was determined in patients with ARF>
Myalgias in 14 patients (23.7%) and a decrease in strength in 11 patients (18.6%) were the main clinical manifestations observed. As a sole cause, convulsion was the most frequent manifestation in 11 patients (18.6%) followed by muscular compression in 10 patients (16.9%). In the plurietiologic group the most frequent manifestation was muscular compression in 5 patients (16.9%) followed by alcoholism in 4 patients (6.7%). No differences were found in either the clinical manifestation or the biology of the RM among the different etiologies. Eight patients presented ARF (13.5%) with one patient requiring dialysis, and good response being observed with conservative treatment in 5 patients. On multivariant analysis the statistically significant ARF predictive factors were: age over 70 years (p = 0.003), nonketotic hyperosmolar diabetic coma (p = 0.01), previous dehydration (p = 0.001) and initial uric acid levels greater than or equal to 6 mg/dl (p = 0.002).
The clinical expression of rhabdomyolysis was small with the most frequent manifestations being convulsions and muscular compression. The predictive factors for acute renal failure were advanced age, nonketotic hyperosmolar diabetic coma, dehydration, and hyperuricemia.
本研究旨在确定非创伤性或医源性横纹肌溶解症（RM）的病因，并分析其临床和生物学特征以及急性肾衰竭（ARF）的预测因素。
对18个月内内科收治的59例RM患者进行前瞻性研究。将患者分为病因组。进行了问诊、体格检查和包括肌酸激酶、肌红蛋白、醛缩酶、镁和蛋白电泳在内的常规分析研究。对发生ARF的患者测定尿钠。
观察到的主要临床表现为14例患者（23.7%）出现肌痛，11例患者（18.6%）出现肌力下降。作为唯一病因，惊厥是11例患者（18.6%）最常见的表现，其次是10例患者（16.9%）出现肌肉受压。在多病因组中，最常见的表现是5例患者（16.9%）出现肌肉受压，其次是4例患者（6.7%）出现酒精中毒。不同病因的RM在临床表现或生物学方面均未发现差异。8例患者出现ARF（13.5%），1例患者需要透析，5例患者经保守治疗效果良好。多变量分析显示，具有统计学意义的ARF预测因素为：年龄超过70岁（p = 0.003）、非酮症高渗性糖尿病昏迷（p = 0.01）、既往脱水（p = 0.001）和初始尿酸水平大于或等于6mg/dl（p = 0.002）。
横纹肌溶解症的临床症状较轻，最常见的表现是惊厥和肌肉受压。急性肾衰竭的预测因素为高龄、非酮症高渗性糖尿病昏迷、脱水和高尿酸血症。
