以发热为首发表现的皮肌炎患者临床特征分析  

Clinical features of dermatomyositis with fever as the initial manifestation

作　　者：郑丽[1] 刘燕[1] 李俊男[2] 赵文鹏[1] Zheng Li;Liu Yan;Li Junnan;Zhao Wenpeng(Department of Rheumatology,Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院风湿免疫科,太原030001 [2]山西医科大学第二医院心内科,太原030001

出　　处：《中国药物与临床》2020年第11期1789-1792,共4页Chinese Remedies & Clinics

摘　　要：目的探讨以发热为首发表现的皮肌炎(DM)患者的临床特点。方法将71例DM患者按首发症状有无发热进行分组,起病急缓进行分层,对其临床资料分别进行分析。结果①71例DM患者,发热首发组24例,急性起病(皮疹和肌炎的发生时间≤6月)16例(67%),慢性发病(皮疹和肌炎的发生>9月)8例(33%);非发热首发组47例,急性起病26例(55%),慢性发病21例(45%);②首发表现:24例以发热起病的DM患者,首发症状仅有发热7例(29%),发热伴皮疹13例(54%),发热伴肌无力2例(8%),发热、皮疹和肌无力同时出现2例(8.3%);③皮肤表现:非特征性皮疹在2组急性发病患者中进行比较,16例发热首发组非特征性皮疹占12例(75%),26例非发热首发组非特征性皮疹3例(12%),2组比较差异有统计学意义(P<0.01);④肌炎表现:在急性和慢性起病患者中,肌力Ⅰ~Ⅲ级和肌酸激酶升高的发生率,发热首发组均低于非发热首发组。其中急性起病患者,肌酸激酶升高,发热首发组与非发热首发组相比差异有统计学意义(P<0.05);发热首发组急性起病患者肌电图肌源性损害达87%;⑤系统损害:在急性起病患者中,发热首发组16例,发生系统损害13例(81%),其中11例(69%)为严重的系统损害;非发热首发组26例,系统损害9例(35%),其中3例(12%)严重系统损害,差异均有统计学意义(P<0.05)。结论以发热起病的DM患者起病急,病情危重而临床特点不典型,易延误治疗,一旦确诊后,需高度关注,密切随访。Objective To investigate the clinical features of dermatomyositis(DM)with fever as the initial manifestation.Methods Included in this study were 71 DM patients who were grouped according to fever being the initial symptom and further stratified by acute/chronic onset of DM.The clinical data of the patients were analyzed.Results①Of the 71 DM patients,24 presented fever as the initial symptom,among whom,the disease onset was acute(appearance of rash and myositis within≤6 months)in 16(67%)and chronic(appearance of rash and myositis in>9 months)in 8(33%);47 did not present fever as the initial symptom,among whom,the disease onset was acutein26(55%)and chronic in 21(45%).②Of 24 DM patients who presented fever at the onset of DM,the initial symptoms included fever alone in 7(29%),fever and rashes in 13(54%),fever and myasthenia in 2(8%),and fever,rashes and myasthenia in 2(8%).③Non-specific skin rashes were found in 12(75%)out of 16 patients with fever as the initial symptom and in 3(12%)out of 26 patients without fever.There was a significant difference between the two subgroups(P<0.001).④Myositis manifestation:in either acute or chronic-onset DM,the proportions of gradesⅠ-Ⅲmuscle strength and creatine kinase elevation were lower in patients with fever as the initial symptom than those without.In acute-onset DM,the proportion of creatine kinase elevation differed statistically between patients with and without feveras the initial symptom(P<0.05).86.7%of patients with acute-onset DM and fever as the initial symptoms showedmyogenic damage on electromyography.⑤Systemic damages:among the patients with acute-onset DM,13(81%)out of16 patients with fever as the initial symptom suffered systemic damages,including 11(69%)severe cases;9(35%)out of 26 patients without fever as the initial symptom suffered systemic damages,including 3(12%)severe cases.The difference was statistically significant(P<0.05).Conclusion DM with fever as the initial symptom may feature acute onset,critically ill conditions and atypical c

关 键 词：皮肌炎 发热 

分 类 号：R593.26[医药卫生—内科学]