成年型皮肌炎的早期主要病理改变  

An early pathological changes for adult dermatomyositis

作　　者：袁云[1] 王朝霞[1] 陈清棠[1] 

机构地区：[1]北京医科大学附属第一医院神经内科,100034

出　　处：《中华神经科杂志》2000年第1期36-38,共3页Chinese Journal of Neurology

摘　　要：目的　探讨微血管病理改变在皮肌炎发病中的表现规律及其诊断价值。方法　对 2例光镜下无典型病理改变的皮肌炎病人在光镜和电镜下观察微血管改变。结果　 2例病人均为成年男性 ,例 1出现严重四肢肌疼痛无力和皮肤损害 6天 ,例 2出现四肢皮肤损害和肌肉疼痛 2个月 ,无肌无力。 2例肌电图均显示肌源性损害。肌肉活检显示个别肌纤维坏死和萎缩 ,无炎细胞浸润和束周性肌萎缩 ,可见大量非特异性酯酶深染的小血管。电镜下毛细血管出现坏死和再生 ,内皮细胞内可见管网包涵体。结论　微血管病变是成年型皮肌炎主要病理改变 ,早于束周性肌萎缩和炎细胞浸润 ,应为皮肌炎病理诊断的指标之一 ,特别是此病的早期阶段或轻微病人。Objective To study the microvascular changes in the early stage of adult dermatomyositis. Method Two adult patients with dermatomyositis were studied in the early stage of the disease clinically and myopathologically. Results Both cases showed typical clinical symptoms with serological and electromyographical features for dermatomyositis. Muscle biopsies showed intramuscular vessels with intensive staining of non specific esterase, but minimal fiber necrosis and atrophy. Electron microscopy revealed necrosis and regeneration of capillary in which numerous microtubular inclusions appeared in their endothelial cells. Conclusions Our study demonstrated that microvasculopathy was an earlier pathological change than inflammatory infiltration and perifascicular atrophy in adult dermatomyositis. A microvasculopathy should be considered in diagnostic criteria of dermatomyositis, especially in the early or mild cases.

关 键 词：皮肌炎 包涵体 活组织检查 病理 

分 类 号：R593.26[医药卫生—内科学]