Moxley R T
University of Rochester Medical Center, New York.
Rheum Dis Clin North Am. 1994 Nov;20(4):827-43.
The assessment of neuromuscular function during the course of treatment in patients with inflammatory myopathy requires a combination of tests tailored to the clinical status of the patient. The use of timed functional tests, pulmonary function, functional grading, and manual muscle strength testing (coordinated with a physical therapist) provides the clinician and patient with reliable, easily performed measurements that are flexible enough for virtually all outpatient settings. Some patients may require assessment with only timed functional tests, such as the time to run 30 feet, climb four steps, and arise from supine to standing; other patients may need an assessment that uses function tests, functional grade scoring, and manual muscle strength testing. The 24-hour urinary excretion of creatinine is a simple method to measure changes in muscle mass, and determinations at 3- to 6-month intervals may provide a useful means to document the effects of treatment. Occasionally, more elaborate methods, such as MR imaging of muscle may be necessary to identify persistent inflammation in certain muscles or aid in the selection of a specific area of muscle to biopsy. The use of myometry, especially fixed myometry with QMT, is most suitable for clinical research. In the future, hand-held myometric equipment and, perhaps, even QMT, may become more adaptable to office practice, and their use will be more feasible for the routine care of patients with inflammatory myopathy.
在炎性肌病患者的治疗过程中，对神经肌肉功能的评估需要结合根据患者临床状况定制的多种检查。使用定时功能测试、肺功能、功能分级和徒手肌力测试（与物理治疗师协作），可为临床医生和患者提供可靠且易于实施的测量方法，这些方法足够灵活，适用于几乎所有门诊环境。一些患者可能仅需通过定时功能测试进行评估，比如跑30英尺、爬四级台阶以及从仰卧位起身站立所需的时间；其他患者可能需要采用功能测试、功能分级评分和徒手肌力测试进行评估。24小时尿肌酐排泄是测量肌肉量变化的一种简单方法，每隔3至6个月进行测定可能是记录治疗效果的一种有用手段。偶尔，可能需要更精细的方法，如肌肉磁共振成像，以识别某些肌肉中的持续性炎症，或辅助选择特定的肌肉区域进行活检。使用肌测力法，尤其是采用定量肌测力法的固定肌测力法，最适合临床研究。未来，手持式肌测力设备甚至定量肌测力法可能会更适用于门诊实践，并且它们的使用对于炎性肌病患者的常规护理将更加可行。
