持续性血液净化在重症多发性肌炎和皮肌炎中的器官保护作用:1例报告  

Organ-protective effect of continuous renal replacement therapy in a patient with severe polymyositis and dermatomyositis

作　　者：刘占国 周健[1] 岑仲然[1] 唐颖[1] 杨祥锐[1] 常平[1] 

机构地区：[1]南方医科大学珠江医院重症医学科,广东广州510282

出　　处：《南方医科大学学报》2012年第6期854-856,共3页Journal of Southern Medical University

基　　金：国家自然科学基金(81101451);广东省自然基金(S2011010003106);广东省医学科学技术研究基金(B2011208)~~

摘　　要：对1例病因不明的"广泛皮疹、皮肤剥脱、无尿、全身浮肿、呼吸困难"患者行持续血液净化治疗,动态观察各器官损伤情况的变化,之后在患者病变部位行组织活检。患者病理结果为多发性肌炎/皮肌炎,持续性血液净化治疗开始后心、肝、肾、肺各项指标快速好转,表现为尿量快速增加,肺部炎症逐渐减轻,血肌酐、尿素、总胆红素、谷丙转氨酶、谷草转氨酶、肌酸激酶、肌酸激酶同工酶和乳酸脱氢酶水平快速回落,治疗结束后各项生化指标仍保持下降趋势,患者顺利出院。持续性血液净化在本例重症多发性肌炎/皮肌炎的治疗中疗效显著,在自身免疫性疾病,尤其是全身性炎症疾病的急性期可以作为一种治疗选择。A patient with skin rash, skin denudation, anuria, general dropsy and dyspnea for unknown etiology underwent continuous renal replacement therapy （CRRT） for 3 consecutive days. The biochemical indexes were monitored during the therapy and biopsy was performed on the right thigh. Pathological examination of the biopsy sample established the diagnosis of polymyositis（PM） and dermatomyositis（DM）. After the start of CRRT, the patient＇s heart, liver, kidney and lung injuries showed obvious improvement, and the urine volume （UV） increased and serum creatinine （Cr）, urea, total bilirubin （TBIL）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, creatine kinase （CK）, creatine kinase isoenzyme （CK-MB） and lactate dehydrogenase （LDH） levels all decreased promptly. The patient showed progressive improvement of the physiological condition even after CRRT, and was discharged 10 clays later. This case suggests the efficacy of CRRT in the management of severe PM/DM and its value as a good option for treatment of severe autoimmune disease, especially systemic inflammatory response syndrome.

关 键 词：多发性肌炎 皮肌炎 持续性血液净化 器官保护 

分 类 号：R746[医药卫生—神经病学与精神病学] R593.26[医药卫生—临床医学]