中华皮肤科杂志 ›› 2009, Vol. 42 ›› Issue (1): 19-21.

• 论著 • 上一篇    下一篇

皮肌炎患者Gottron皮疹与肺间质病变

阮晨曦 郑捷   

  1. 上海交通大学医学院附属瑞金医院皮肤科 上海交通大学医学院附属瑞金医院皮肤科
  • 收稿日期:2008-04-08 修回日期:2008-05-08 出版日期:2009-01-15 发布日期:2009-01-15
  • 通讯作者: 阮晨曦 E-mail:ruanchenxi@yahoo.com.cn

Gottron papules and interstitial lung disease in patients with dermatomyositis

  • Received:2008-04-08 Revised:2008-05-08 Online:2009-01-15 Published:2009-01-15

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摘要：

目的 探讨皮肌炎（DM）患者中Gottron皮疹与肺间质病变（ILD）的关系。方法 回顾分析83例皮肌炎患者的临床资料，根据有无Gottron皮疹分组，比较两组的临床特点。结果 DM患者Gottron皮疹的总阳性率为59%（49/83例），ILD的发生率为42.2%（35/83例），Gottron皮疹阳性组ILD的发生率明显低于Gottron皮疹阴性组，两者差异有统计学意义（24.5%比67.6%，P ＜ 0.01）。35例ILD中Gottron皮疹阴性者的CO弥散率（DLCO）明显低于Gottron皮疹阳性者（60.9 ± 13.5比72.3 ± 12.7，P ＜ 0.05）。Gottron皮疹阳性组与阴性组的肌力（4.0 ± 0.9比3.8 ± 1.2，P ＞ 0.05）、肌肉压痛（63.3%比70.6%，P ＞ 0.05）、肌酶水平（肌酸磷酸激酶1047.9 ± 1402.7比1359.7 ± 1752.4，乳酸脱氢酶397.2 ± 226.5比402.4 ± 197.0，AST 97.6 ± 98.0比120.1 ± 82.3，P均 ＞ 0.05）比较差异无统计学意义。两组的ESR、CRP水平比较差异亦无统计学意义（分别为26.5 ± 16.4比33.3 ± 25.3，11.9 ± 8.3比15.5 ± 9.8，P均 ＞ 0.05）。Gottron皮疹阳性组与阴性组恶性肿瘤的发生率差异无统计学意义（21.4%比6.5%，P ＞ 0.05）。结论 Gottron皮疹阳性的皮肌炎患者伴发肺间质病变的可能性小，且病变程度可能较轻。Gottron皮疹与DM的肌肉病变程度及病情活动无明显关系，Gottron皮疹可能与恶性肿瘤的发生无明显关系。

关键词: 皮肌炎，Gottron’s皮疹，肺间质病变

Abstract:

Objective To assess the relationship between Gottron papules and interstitial lung disease （ILD） in patients with dermatomyositis. Methods Clinical data were retrospectively collected from 83 patients with dermatomyositis （DM）, who were classified into two groups based on the presence of Gottron papules. Results The prevalence of Gottron papules and ILD was 59.0% and 42.2%, respectively in these patients. A significant difference was observed in the incidence of ILD between patients with and without Gottron papules （24.5% vs 67.6%, P < 0.01）. In the patients with ILD, the average value of diffusing capacity of the lung for carbon monoxide （DLCO） in those without Gottron papules was significantly lower than that in those with Gottron papules （60.9 ± 13.5 vs 72.3 ± 12.7, t = 2.427, P < 0.05）. No significant difference was observed between the patients with Gottron papules and those without in muscle strength （4.0 ± 0.9 vs 3.8 ± 1.2）, the level of serum creatine phosphokinase （1047.9 ± 1402.7 IU/L vs 1359.7 ± 1752.4 IU/L）, lactic acid dehydrogenase （397.2 ± 226.5 IU/L vs 402.4 ± 197.0 IU/L）, aspartate aminotransferase （97.6 ± 98.0 IU/L vs 120.1 ± 82.3 IU/L），C reactive protein （11.9 ± 8.3 mg/L vs 15.5 ± 9.8 mg/L）, erythrocyte sedimentation rate （26.5 ± 16.4 mm/1 h vs 33.3 ± 25.3 mm/1 h）, the incidence of muscle tenderness （63.3% vs 70.6%） or malignant melanoma （21.4% vs 6.5%）. Conclusions Patients presenting Gottron papules tend to show a decreased incidence and severity of ILD. No significant association was observed between the presence of Gottron papules and the degree of muscle changes or dermatomyositis activity, and the presence of Gottron papules seems to have no obvious relationship to the development of malignant melanoma.

Key words: Dermatomyositis, Gottron's eruption，interstitial lung disease