64例风湿性多肌痛临床特点及诊治分析  

Clinical characteristics,diagnosis and treatment of 64 cases of polymyalgia rheumatica

作　　者：戴巧定[1] 宋欣伟[1] 

机构地区：[1]浙江中医药大学附属第一医院风湿免疫科,杭州市310006

出　　处：《中华全科医学》2015年第5期725-727,768,共4页Chinese Journal of General Practice

摘　　要：目的探讨风湿性多肌痛(PMR)的临床特点及浅谈诊治体会,提高对风湿性多肌痛的认识,减少漏诊和误诊。方法回顾性分析64例风湿性多肌痛患者的临床表现、实验室检查、影像学和诊治情况。结果女性多见,男∶女=1∶2.76,平均年龄(65.67±10.49)岁,平均病程(5.41±5.22)个月。临床表现均有不同程度的颈肩痛、骨盆带肌痛,其中以肩、骨盆带肌痛两处同时受累者最多;其次为晨僵,再次为关节肿痛、发热、乏力及体重下降等非特异性表现。所有患者均有血沉及C反应蛋白明显升高,分别为(76.79±21.09)mm/h及(52.03±37.49)mg/L。50%(32/64)的患者合并贫血,绝大部分为轻度贫血;50%以上(37/64)患者出现铁蛋白升高(531.84±165.02)ng/ml,26.4%(14/53)的患者HLA-B27阳性。MR提示关节周围炎症改变。63例患者需用糖皮质激素或激素联合免疫抑制剂治疗,1例单用非甾体抗炎药治疗有效。经治疗后临床症状缓解,时间为(8.69±5.65)d;炎性指标改善,血沉和C反应蛋白恢复正常时间分别为(16.42±8.53)d和(7.98±2.83)d。复发率为28.1%(18/64)。结论对于50岁以上患者出现急性或亚急性颈、肩、骨盆带肌的疼痛,应考虑PMR的可能。对于疑诊患者可应用超声或MR检查协助诊断。Objective To explore the clinical characteristics,diagnosis and management of polymyalgia rheumatica（ PMR） and reduce the rates of missed diagnosis and misdiagnosis. Methods The data of 64 consecutive patients with PMR were retrospectively analyzed,including clinical manifestations,laboratory features,imaging techniques,diagnosis,therapeutic procedures and prognosis. Results The incidence of PMR was more common in females,with the sex ratio of male to female 1∶ 2. 76,a mean age of（ 65. 67 ± 10. 49） years; the average duration were（ 5. 41 ± 5. 22） months. The symptoms included bilateral pain and stiffness in the neck,shoulders and hip girdles,and the late two symptoms involved were more seen,followed by morning stiffness and systemic symptoms such as articular pain,fever,hypodynamia and weight loss. Elevated ESR and CRP were revealed in all patients by（ 76. 79 ± 21. 09） mm / h and（ 52. 03 ± 37. 49） mg / L.Anemia was noted in 50%（ 32 /64） of the cases in our study with majority having mild anemia. More than half of the patients were with elevated ferritin（ 531. 84 ± 165. 02） ng / ml. 26. 4%（ 14 /53） of patients were HLA-B27 positive. MRI typically show a predominantly periarticular inflammatory process. 63 cases required single medication of glucocorticoid or combined glucocorticoid with immunosuppressive agents,and 1 case was managed with simple nonsteroidal anti-inflammatory agent. The average time to reach clinical remission was（ 8. 69 ± 5. 65） days,meanwhile the time of elevated ESR and CRP recovering to normal was（ 16. 42 ± 8. 53） days and（ 7. 98 ± 2. 83） days,respectively. Relapses were common and arose in roughly 28. 1%（ 18 /64） of patients. Conclusion The presenting symptoms are nonspecific but PMR should be suspected in patients aged over 50 who have sub-acute or acute onset of bilateral,severe and persistent pain in the neck,shoulders and pelvic girdle. The suspected patients can be applied to ultrasound or MR scan in diagnosis.

关 键 词：风湿性多肌痛 临床特点 糖皮质激素 

分 类 号：R593.2[医药卫生—内科学]