【作者】 洪冰聪；

【导师】 王柠；

【作者基本信息】 福建医科大学 ， 神经病学， 2010， 硕士

【摘要】 目的:探讨多发性肌炎患者激素治疗抵抗的影响因素。方法:选择福建医科大学附属第一医院2002.6-2009.11住院的符合B/P诊断标准的多发性肌炎患者93例,参考2005年顾越英的定义:激素大剂量(>1~2mg/kg.d)1个月,仍不能改善症状和使肌酶正常化者,称为激素抵抗,反之为激素敏感,对该93例患者进一步筛选,未治疗或疗程不足,激素量未达上述标准,1个月未复查肌酶者均予排除。结果:激素敏感组20例,男性9例,女性11例,平均年龄39岁;抵抗组39例,男性11例,女性28例,平均年龄44岁,排除34例。研究因素为临床表现和相关实验室检查,共9项,包括:性别、发病年龄、咽喉肌受累、肌力轻重、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病、血清肌酸激酶,通过调查病历及随访获得,按统一的标准,填写到统一的调查表中,并采用SPSS(11.0)统计软件,单因素分析采用卡方检验、秩和检验,多因素分析采用Logistic回归分析。除此9项因素外,并调查患者的胸部影像学检查、自身抗体谱、血清免疫球蛋白、甲状腺功能、肌电图检查等情况。结果:单因素分析:血清肌酸激酶,p=0.000;肌力,OR=3.882,p=0.022;而性别、发病年龄、咽喉肌受累、肝脾淋巴结肿大、心脏累及、伴发肿瘤、伴发结缔组织病等因素未见统计学意义。多因素分析:血清肌酸激酶升高为独立危险因素。另外发现有4例肌电图提示肌强直者均为激素抵抗患者。结论:1、血清肌酸激酶增高为多发性肌炎患者激素治疗抵抗的独立危险因素,有待进一步验证。2、性别、发病年龄、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病等本研究尚不能明确其为激素治疗抵抗的危险因素。3、肌电图提示肌强直者可能为激素抵抗的危险因素,值得进一步研究。更多还原

【Abstract】 Objective : To investigate the influence factors of treatment that refractory to corticosteroids in polymyositis.Methods:93 in-patients with polymyositis were investigated from Jun 2002 to November 2009 in First Affiliated Hospital of Fujian Medical University. Following Gu’s definition in 2005:When treated with corticosteroids dose>1 ~ 2mg/kg.d for one month,the symtoms still can not be improved or creatine kinase is still abnormal, it is called steroids-resistance, whereas the steroids-sensitivity.Patients without adequate treatment, or without reviews of CK one month later were exclued.Dived them into two groups,20 patients with steroids-senstive and 39 with steroids-restistent,33 patients were exclued.Clinical and laboratory data were collected ,including Sex, age, throat muscle involvement, muscle weight, heart involved, hepatosplenomegaly and lymphadenopathy, associated with cancer, associated with connective tissue disease, elevated serum creatine kinase .The data was analyzed by SPSS software,respectively by mono-factor analysis and Logistic regression test. The data of chest radiographic findings, autoantibody spectrum, immune serum globulin, thyroid function, EMG, were also collected.Results: mono-factor analysis:CK,p=0.000;musle strength, OR=3.88,p=0.022; There were no differences in sex, age, throat muscle involvement, heart involved, hepatosplenomegaly and lymphadenopathy,associated with cancer and connective tissue disease by statistics. Logistic regression test:Elevated CK is an independent risk factor.In addition, Four patients with Myotonia in EMG all refractory to corticosteroids.Conclusions:1.CK evaluate is one independent risk factor of refractory to corticosteroids with polymyositis,should be confirmed.2. Sex, age, throat muscle involvement, heart involved, associated with cancer, associated with connective tissue disease cannot be defined as a risk factor in this study.3. Myotonia in EMG may be a risk factor of refracting to corticosteroids.更多还原