成人多发性肌炎或皮肌炎心脏损害的系统性定性评价研究  

Cardiac involvements in adult polymyositis or dermatomyositis： a qualitative systematic review

作　　者：章璐[1] 乔薇[2] 王国春[3] 

机构地区：[1]中国医学科学院北京协和医学院研究生院,100032 [2]中日友好医院高干医疗科 [3]中日友好医院风湿免疫科

出　　处：《中华风湿病学杂志》2012年第3期167-172,共6页Chinese Journal of Rheumatology

基　　金：基金项目：北京市科委资助项目（D101100050010018）

摘　　要：目的探讨成人多发性肌炎或皮肌炎心脏损害的临床特点。方法计算机检索Pubmed、EMbase、中国生物医学文献数据库、维普咨询网中文科技期刊数据库、万方和清华同方数据库，阅读相关文献，根据入选和排除标准纳入研究文献，采用荟萃分析方法对研究结果进行汇总分析。结果共有23篇文献纳入本研究，病例总数1452例。多发性肌炎／皮肌炎伴发心脏损害的发生率为27．1％。85％。3％～6％的多发性肌炎，皮肌炎患者有心脏损害的临床症状，其中以心力衰竭最常见（43．8％。76．9％）。异常心电图和超声心动图检查结果中，各种传导阻滞、左室舒张功能减低及左室高动力发生率分别为25％～38．5％，27．3％～51．5％和11．5％～42．3％。心肌病理表现为肌纤维变性、坏死和炎症细胞浸润。激素和免疫抑制剂治疗对部分患者的心脏损害有效。1452例患者中有97例死亡病例，其中有30例（30．9％）直接死亡原因为、心脏疾病。结论心脏受累是多发性肌炎，皮肌炎常见并发症，绝大部分为亚临床表现。激素及免疫抑制剂的作用尚不确定。心脏损害是常见的死亡原因。Objective To investigate the clinical features of cardiac involvement in polymyositis or dermatomyositis （PM/DM）. Methods All articles published in Chinese and English were retrieved by searching the electronic resource databases. The eligible articles that met the predefined inclusion and exclusion criteria were included and then a systemic review was performed. Results Totally 23 articles were enrolled in this study, including 1452 patients. The incidence of cardiac involvement was 27.1%-85%. Heart failure was the most frequent （43.8%-76.9%） symptom. Among the abnormal ECG and UCG, the incidence of conduction abnormalities, left ventricular diastolic dysfunction and hyperkinetic left ventricular contraction 25%-38.5%, 27.3%,51.5% and 11.5%-42.3% respectively. The pathological findings revealed myocardial in- flamma-tion; degenerative changes and necrosis similar to those findings in skeletal muscles. Some patients＇ condition were improve：d after gluco-corticoid stero and immunosuppressant treatment. Thirty patients （30.9%） died as a direct result of heart disease. Conclusion Heart abnormalities are common in patients with PM/DM, most of them are subclinical,however. The efficacy of gluco corticoid steroid and immunosup- pressant treatment are uncertain. Cardiac involvement is a common cause of death.

关 键 词：多发性肌炎 皮肌炎 心脏病 系统评价 

分 类 号：R593.26[医药卫生—内科学]