Fernández-Solá J, Pedrol E, Masanés F, Casademont J, Grau J M, Urbano-Márquez A
Servicio de Medicina Interna. Hospital Clinic i Provincial, Barcelona.
Med Clin (Barc). 1993 May 15;100(19):721-4.
Toxic myopathies are a frequent cause of acquired myopathy in adults. The type of drugs or toxins involved varies greatly according to the epidemiologic context in which they are evaluated. An etiological, clinical and histological review of the toxic myopathies diagnosed in a group of study of muscular diseases in a third level hospital was carried out.
An eight year retrospective study of clinical and histological review of patients in whom muscle biopsy was performed to diagnose toxic myopathies in the Hospital Clinic i Provincial of Barcelona was performed.
The most frequent causes of toxic myopathy with clinical relevance were those due to the consumption of zidovudin, ethanol, prednisone, heroin, and neuroleptic, hypolipemiant and diuretic drugs, with other causes being less frequent. In 52% of the cases an elevation of muscle enzymes (creatinkinase) was observed. In 51% it was attributed to the administration of a drug at therapeutic doses, in 34% to voluntary intoxication (attempt at autolysis or drug dependence) and in 15% the cases were accidental. The histologic study of the muscle biopsy was normal in 10% of the cases and changes indicative of a determined etiology were observed in 65% and were non-specific in the remaining 25%. More than a half of the patients were asymptomatic at 3 months of initiation of the symptoms.
Toxic myopathies often follow a paucisymptomatic form. Most have a non-specific histologic substrate and improve upon suppression of the producing cause. The performance of muscle biopsy gives positive or negative clinically useful information in 60% of the cases, by discarding other possible causes of myopathy.
中毒性肌病是成人获得性肌病的常见病因。所涉及的药物或毒素类型因评估时的流行病学背景而异。对一家三级医院肌肉疾病研究组中诊断出的中毒性肌病进行了病因、临床和组织学回顾。
对巴塞罗那省立医院诊所进行肌肉活检以诊断中毒性肌病的患者进行了为期八年的临床和组织学回顾性研究。
具有临床相关性的中毒性肌病最常见的病因是服用齐多夫定、乙醇、泼尼松、海洛因、抗精神病药、降血脂药和利尿药，其他病因较少见。52%的病例观察到肌肉酶（肌酸激酶）升高。51%归因于治疗剂量的药物给药，34%归因于自愿中毒（自溶企图或药物依赖），15%的病例为意外情况。10%的肌肉活检组织学研究正常，65%观察到表明特定病因的变化，其余25%为非特异性变化。超过一半的患者在症状出现3个月时无症状。
中毒性肌病通常表现为症状轻微。大多数具有非特异性组织学基础，去除致病原因后病情改善。在60%的病例中，肌肉活检通过排除其他可能的肌病病因，提供了临床上有用的阳性或阴性信息。
