Lacomis D, Chad D A, Smith T W
Department of Neurology, University of Massachusetts Medical Center, Worcester 01655.
Neurology. 1993 Apr;43(4):825-8. doi: 10.1212/wnl.43.4.825.
We undertook a retrospective clinicopathologic study to ascertain the spectrum of histopathologic muscle biopsy changes in the elderly thought to have a myopathy, and to determine the accuracy of clinical diagnosis of myopathy in the elderly compared with a younger control population. We compared muscle histology and case histories, as well as EMG and creatine kinase (CK) data, obtained over 10 years from 77 consecutive patients aged 65 years or older (75 +/- 6, mean +/- SD; group 1) with those from 104 patients aged 30 to 50 years (group 2). Prominent myopathic features were present in 42% (group 1) versus 51% (group 2) of all biopsies. Neurogenic changes (17% versus 9%, p < 0.04) and type II fiber atrophy (22% versus 6%, p < 0.0005) were more common in the elderly, whereas normal findings tended to be less frequent (19% versus 35%). In at least 68% of patients in both groups with the histologic diagnosis of myopathy, either the CK was elevated or the EMG was consistent with that diagnosis. Our study indicates that (1) the spectrum of histopathologic changes in the two groups differs because of a higher frequency of neurogenic change and type II atrophy in the elderly, and (2) the accuracy of clinical diagnosis of myopathy in the elderly approximates that in a younger population.
我们进行了一项回顾性临床病理研究，以确定被认为患有肌病的老年人肌肉活检组织病理学变化的范围，并与年轻对照人群相比，确定老年人肌病临床诊断的准确性。我们比较了连续77例65岁及以上患者（75±6，平均±标准差；第1组）和104例30至50岁患者（第2组）在10年期间获得的肌肉组织学、病史以及肌电图和肌酸激酶（CK）数据。所有活检中，明显的肌病特征在第1组中占42%，在第2组中占51%。神经源性改变（17%对9%，p<0.04）和II型纤维萎缩（22%对6%，p<0.0005）在老年人中更常见，而正常结果则较少见（19%对35%）。在两组中至少68%组织学诊断为肌病的患者中，要么CK升高，要么肌电图与该诊断一致。我们的研究表明：（1）两组组织病理学变化范围不同，因为老年人神经源性改变和II型萎缩的发生率较高；（2）老年人肌病临床诊断的准确性与年轻人群相近。
