Fernández-Fúnez A, Segura Luque J C, Tirado Miranda R, de Tomás Labat E
Servicio de Medicina Interna, Hospital General de Albacete.
Rev Clin Esp. 1997 Nov;197(11):745-51.
To investigate the characteristics of medical rhabdomyolysis (RM) in the elderly, as well as differences compared with those observed in younger patients.
Prospective study of 56 elderly patients (> or = 65 years) with RM and 73 younger patients (> 7 years and < 65 years) with RM for 43 months. The RM characteristics were analyzed in the elderly group (ERM) and compared with those in the younger group (YRM).
Fifty-six elderly patients with RM (38 males and 18 females, with a mean age of 76.3 +/- 7.6 years; range: 65-92 years) and 73 younger patients (57 males and 16 females, with a mean age of 37.9 +/- 15.6 years; range: 13-63 years), made up the 129 patients in the study. The most common cause for RM in the ERM was muscle compression due to immobilization and the multicausative group, both with 9 (16%) cases, followed by respiratory infection with 8 (14.2%) cases. In the YRM, the most common cause was physical exertion with 15 patients (20.5%) and multicausative with 18 patients (24.6%). Myalgia predominated in the YRM group, with 25 vs. 9 (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.0-7.3; p < 0.05). Acute renal failure (ARF) occurred in 13 patients in the ERM group compared with 4 in the YRM group (OR: 5.2; 95% CI: 1.4-23; p < 0.01). In the logistic regression analysis an association was found between hypoalbuminemia and ARF for the ERM group. In the presence of ARF, both ERM and YRM had decreased serum calcium levels, deeper in YRM and more prolonged in the ERM. Six patients in the ERM died, and four of them had developed ARF. In contrast, none of the two deceased patients in the YRM had the complication of ARF.
Almost half of cases of RM occur in elderly patients, which is mostly due to muscle compression and infections, particularly in the respiratory tract. Symptoms are usually mild and the development of ARF is more common than in younger patients, and its presence is associated with hypoalbuminemia. Hypocalcemia associated with ARF was less deep in the elderly, but more persistent than in younger patients. Most deceased patients in the elderly group previously developed ARF.
研究老年人群中医疗性横纹肌溶解症（RM）的特征，以及与年轻患者的差异。
对56例老年RM患者（年龄≥65岁）和73例年轻RM患者（年龄＞7岁且＜65岁）进行了为期43个月的前瞻性研究。分析老年组（ERM）的RM特征，并与年轻组（YRM）进行比较。
本研究共纳入129例患者，其中56例老年RM患者（38例男性，18例女性，平均年龄76.3±7.6岁；范围：65 - 92岁），73例年轻RM患者（57例男性，16例女性，平均年龄37.9±15.6岁；范围：13 - 63岁）。ERM中RM最常见的病因是固定体位导致的肌肉受压和多病因组，均为9例（16%），其次是呼吸道感染，共8例（14.2%）。YRM中最常见的病因是体力活动，有15例患者（20.5%），多病因的有18例患者（24.6%）。YRM组以肌痛为主，有25例，而ERM组为9例（优势比[OR]：2.7；95%置信区间[CI]：1.0 - 7.3；p＜0.05）。ERM组有13例患者发生急性肾衰竭（ARF），而YRM组为4例（OR：5.2；95% CI：1.4 - 23；p＜0.01）。在逻辑回归分析中，发现ERM组低白蛋白血症与ARF之间存在关联。在发生ARF时，ERM和YRM的血清钙水平均降低，YRM降低更明显，ERM持续时间更长。ERM组有6例患者死亡，其中4例发生了ARF。相比之下，YRM组2例死亡患者均无ARF并发症。
几乎一半的RM病例发生在老年患者中，主要原因是肌肉受压和感染，尤其是呼吸道感染。症状通常较轻，ARF的发生比年轻患者更常见，且其发生与低白蛋白血症有关。与ARF相关的低钙血症在老年人中程度较轻，但比年轻患者更持久。老年组大多数死亡患者之前发生了ARF。
