中华皮肤科杂志 ›› 2003, Vol. 36 ›› Issue (1): 35-37.

• 论著 • 上一篇    下一篇

皮肌炎并发间质性肺病32例分析

俞宝田1, 甄莉1, 张承训2   

  1. 1. 中国医学科学院、中国协和医科大学北京协和医院皮肤科, 北京100730;
    2. 中国医学科学院、中国协和医科大学北京协和医院统计学教研组, 北京100730
  • 收稿日期:2002-01-29 出版日期:2003-01-15 发布日期:2003-01-15

Clinical Analysis of 32 cases of Dermatomyositis with Interstitial Lung Disease

YU Bao-tian1, ZHEN Li1, ZHANG Cheng-xun2   

  1. Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
  • Received:2002-01-29 Online:2003-01-15 Published:2003-01-15

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摘要： 目的 探讨皮肌炎(DM)并发间质性肺病(ILD)的临床特点和意义。方法 收集北京协和医院1970-1997年门诊和住院长期随诊的216例DM患者,符合Bohan和Peter1975年诊断标准。随诊2~27年,平均(5.8±4.7)年。DM合并ILD32例,DM无ILD184例。比较两组临床资料和实验室各指标,以这些参数作统计学分析。结果 DM患者中,ILD组初发症状中发热(28.2%)显著多于无ILD组(6.5%),P<0.01。病程中ILD组的发热、关节炎、皮肤溃疡和类风湿因子阳性明显增高,分别为71.9%、62.5%、31.3%和24.1%,无ILD组分别为34.2%、8.7%、8.1%,两组比较,P均<0.01或<0.05。而两组患者眼睑紫红斑、Gottron征、吞咽困难、肌肉痛、肌无力、抗核抗体阳性和肌电图肌源性改变发生率差异均无显著性(P均>0.05)。ILD组32例中死亡13例(40.6%),病情改善15例(46.9%),缓解而停用皮质类固醇4例(12.5%)。184例DM无ILD者死亡30例(16.3%),两组死亡率差异有显著性(P<0.01)。结论 DM患者有ILD者发热、关节炎、皮肤溃疡和类风湿因子阳性明显增多。这组患者治疗困难,死亡率高。

关键词: 皮肌炎, 肺疾病,间质性

Abstract: Objective To study the clinical features and significance of the patients with dermatomyositis(DM)associated with interstitial lung disease(ILD).Methods 216 cases of DM were collected from the Peking Union Medical College Hospital from 1970 to 1997.The criteria for the diagnosis of DM were based on the report of Bohan and Peter in 1975.The mean follow-up period of these patients was 5.8±4.7 years(ranged from 2 to 27 years).The clinical manifestations and laboratory findings of 32 DM patients with ILD were analyzed and compared with those of 184 DM patients without ILD.Results As compared with DM patients without ILD,the DM patients with ILD were more likely to have fever(28.2%vs.6.5%,P<0.01)in the initial symptoms,during the course of the illness the DM patients with ILD were more common to have fever(71.9%vs34.2%,P<0.01),arthritis(62.5%vs34.2%,P<0.01),skin ulcer(31.3%.vs.8.7%,P<0.01)and positive rheumatoid factor(24.1%vs.8.1%,P<0.05).There were no significant differences in heliotrope rash,Gottron's sign,dysphagia,myalgia,myasthenia,positive antinuclear antibodies and myogenic change in EMG between the two groups.Among 32 DM patients with ILD,13(40.6%)patients died,15(46.9%)patients improved,4(12.5%)patients withdrew corticosteroid after remission.Among 184 DM patients without ILD,30(16.3%)cases died.There was a singnificant difference in the death rate(P<0.01)between the two groups.Conclusion Fever,arthritis,skin ulcer and positive rheumatoid factor were significantly increased in DM patients with ILD.These cases are difficult to be treated with a high death rate.

Key words: Dermatomyositis, Lung diseases,interstitial