肌肉活检在横纹肌溶解症病因诊断中的价值  

The value of muscle biopsy in rhabdomyolysis

作　　者：赵亚雯 王丹清 邓健文 俞萌[1] 郑艺明[1] 冷颖琳 张巍[1] 王朝霞[1] 袁云[1] Zhao Yawen;Wang Danqing;Deng Jianwen;Yu Meng;Zheng Yiming;Leng Yinglin;Zhang Wei;Wang Zhaoxia;Yuan Yun(Department of Neurology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院神经内科,100034

出　　处：《中华内科杂志》2019年第12期899-902,903,904,共6页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划(2016YFC1300605)。

摘　　要：目的探讨骨骼肌病理检查在横纹肌溶解症病因诊断中的价值。方法收集2002年1月至2018年12月就诊于北京大学第一医院神经内科并进行肌肉活检的26例横纹肌溶解症患者的临床和肌肉活检资料。结果26例患者中男18例,女8例,发病年龄6~73(37.3±19.6)岁,起病至活检的时间平均为44d。所有患者均为急性发病,出现肌肉疼痛和(或)肌肉无力。血清肌酸激酶1648-92660 U/L,肌肉活检显示非特异性改变12例(个别2型肌纤维萎缩、肌纤维内脂肪滴轻度增多)、坏死性肌病10例(分散出现的坏死和再生肌纤维)、中毒性神经源性损害2例(1型和2型肌纤维角状萎缩、群组化改变)、脂肪累积病1例(肌纤维内大量脂肪滴)和炎性肌肉病1例(肌纤维坏死和再生,伴随炎性细胞浸润)。12例骨骼肌非特异性病理改变患者的诱发因素为短期剧烈运动6例、食物中毒2例,慢性肾脏病、病毒感染、甲状腺功能减退及不明原因各1例;10例骨骼肌坏死性肌病改变患者的诱发因素包括中毒或药物相关7例、甲状腺功能亢进1例及不明原因2例。结论运动诱发的横纹肌溶解症的骨骼肌病理多为轻度非特异性改变,而药物及中毒诱发者多表现为坏死性肌病,原发性肌肉病诱发者罕见。Objective To analyze the diagnostic value of skeletal muscle biopsy in patients with rhabdomyolysis.Methods Clinical and pathological data of 26 patients with rhabdomyolysis from January 2002 to December 2018 undergoing muscle biopsy were collected.Results Eighteen males and 8 females were finally recruited with median age of 6-73(37.3±19.6)years.The average time from onset to biopsy was 44 days(median course was 30 days).All patients had acute manifestations with muscle pain and/or weakness.Serum creatine kinase was between 1648—92660 U/L.Muscle biopsies showed nonspecific changes in 12 cases(a few with type 2 muscle fiber atrophy,slight deposition of lipid droplets),10 cases with necrotizing myopathy(muscle fiber necrosis and regeneration).Toxic neurogenic damages were seen in 2 cases(type 1 and type 2 angular atrophic muscle fibers with group change),lipid storage disease in 1 case(lipid droplets deposit significantly)and idiopathic inflammatory myopathy in 1 case(muscle fiber necrosis and regeneration,with lymphocyte infiltration).The etiology of non-specific pathological changes included short-term strenuous exercise in 6 patients,poisoning in two,chronic kidney disease in one,viral infection in one,hypothyroidism in one and unknown reason in one.As to patients with necrotizing myopathy,seven were poisoning or drug-related,one with hyperthyroidism,two with unknown reason.Conclusions Among the numerous causes of rhabdomyolysis,exercise usually links nonspecific skeletal muscle changes and poisoning or drug-related disorders are commonly associated with necrotic myopathy.Rhabdomyolysis induced by primary myopathy is rare.

关 键 词：横纹肌溶解 骨骼肌病理 病因诊断 

分 类 号：R73[医药卫生—肿瘤]