甲状腺功能减退性肌病误诊为多发性肌炎10例分析

目的探讨甲状腺功能减退性肌病与多发性肌炎容易误诊的原因.方法回顾分析10例甲状腺功能减退性肌病患者的临床表现及实验室检查资料,并复习有关文献.结果甲状腺功能减退性肌病与多发性肌炎在肌肉方面的表现相似,但甲状腺功能检查可以鉴别,左甲状腺素替代治疗有效.结论对于肌肉无力和肌酶升高者需常规检测甲状腺功能.     

貌似多发性肌炎的甲状腺功能减退症

目的 研究甲状腺功能减退症（甲减）在神经肌肉系统的特殊表现以及与多发性肌炎的鉴别。方法 报道3例误诊病例，复习相关文献。结果 甲状腺功能减退性肌病（甲减性肌病）与多发性肌炎的临床表现相似，确诊需要行甲状腺功能检测。结论以单纯神经肌肉受损为主症的甲减容易误诊为多发性肌炎，甲减性肌病可表现为Hoffmann综合征或类多发性肌炎综合征。因此对貌似多发性肌炎的患者有必要做甲状腺功能检测，以避免误诊。     

甲状腺功能减退性肌病误诊为多发性肌炎3例

目的探讨甲状腺功能减退性肌病容易误诊为多发性肌炎的原因。方法回顾分析3例甲状腺功能减退症致多肌炎综合征的临床资料,并复习相关文献。结果甲状腺功能减退性肌病与多发性肌炎可表现为相似的肌炎症状,但甲状腺功能检查可以鉴别,且用甲状腺激素替代治疗效果好。结论临床上对有肌病表现、肌酶显著升高的患者须注意有无甲状腺功能减退症,要考虑甲状腺功能减退性多发性肌炎样综合征,应注意筛查甲状腺功能。     

甲状腺功能减退性肌病18例临床分析

目的了解甲状腺功能减退性肌病患者的临床特点。方法对2005—2009年收治的甲状腺功能减退性肌病患者18例临床表现和实验室检查等进行回顾分析。结果甲状腺功能减退性肌病主要表现为近端肌无力、肌痛、肌强直、肌肥大等,肌酶谱明显升高,甲状腺激素替代治疗敏感,短期加用中等剂量糖皮质激素可能有助肌肉症状改善。结论甲状腺功能减退性肌病多具有肌无力、肌痛等肌肉症状,肌酶谱明显升高,应注意鉴别诊断。     

甲状腺功能减退性多发性肌炎样综合征1例

报道1例甲状腺功能减退性多发性肌炎样综合征病人,了解甲状腺功能减退性多发性肌炎样综合征的临床表现特点、诊断及鉴别诊断、治疗及预后情况,以提高对该病的认识,指导治疗。     

甲状腺功能减退性肌病18例分析

目的 了解甲状腺功能减退性肌病(HTM)的特点.方法 对18例HTM的临床资料和实验室检查进行分析.结果 HTM可表现为肢体近端肌无力、肌肉酸痛、肌痉挛、肌强直样改变、活动后肌僵硬.给予甲状腺素替代治疗可获得满意效果.结论 对有肌病表现,肌酶升高的患者,应检查甲状腺功能,避免误诊为多发性肌炎或其他疾病.     

以肌损害为主要表现的原发性甲状腺功能减退症五例

目的提高对重症原发性甲状腺功能减退症伴随肌病患者临床特征、病变特点及其治疗的认识。方法回顾性分析1996年3月至2003年11月收治的5例重症原发性甲状腺功能减退伴肌损害患者的临床资料及治疗转归,并结合相关文献对该病的临床特点进行分析。结果5例患者突出的临床表现为对称性近端肌无力、气短、胸痛、呼吸及吞咽困难。血肌酸激酶均显著增高(2 885~10 450 U/L)。结论应将伴有肌损害的原发性甲状腺功能减退症患者与多发性肌炎鉴别,及时给予甲状腺激素替代治疗对甲状腺功能减退相关性肌病有较好疗效。     

内分泌性肌病误诊为多发性肌炎的诊治分析并相关文献复习

目的 通过分析误诊病例,提高临床医师对内分泌性肌病的诊治水平.方法 分析总结2011-2013年我院收治的4例误诊为多发性肌炎的内分泌性肌病患者的临床特点,并结合相关文献进行复习.结果 4例误诊病例中2例诊断为原发性甲状腺功能减退症,1例诊断为甲状腺功能亢进症,1例诊断为高醛固酮血症.依据一般资料和相关检查明确诊断后给予对症治疗,4例患者均明显好转.结论 内分泌性肌病是多发性肌炎常见的误诊疾病之一,临床医师需加强鉴别诊断,避免误诊.     

多发性肌炎/皮肌炎之外的特发性炎症性肌病

特发性炎症性肌病是指病因不明,主要表现为肌痛、肌无力,血清肌酶谱升高、肌电图呈肌源性改变、肌肉组织活检可显示炎性细胞浸润的一组肌病,包括多发性肌炎/皮肌炎、包涵体肌炎、甲状腺功能减退性肌病、结节性肌炎、嗜酸性多发性肌炎和横纹肌溶解综合征等,临床工作中常易误诊、     

甲状腺功能减退性肌病误诊16例分析

目的探讨甲状腺功能减退性肌病误诊的原因及如何有效预防。方法通过对我院近5年收治的甲状腺功能减退性肌病误诊的16例患者进行临床分析。结果 8例误诊为多肌炎,4例误诊为重症肌无力,4例误诊为冠心病。结论详细询问病史,仔细查体,有针对性的检查甲状腺功能,是防止误诊的基础。     

甲状腺机能减退性肌病激素替代治疗前后血清肌酶谱的变化

目的　探讨甲减肌病患者甲状腺激素替代治疗前后血清肌酶谱的变化。方法　分别检测 2 5例甲减肌病患者治疗前后血清肌酸激酶及其同工酶、乳酸脱氢酶、门冬氨酸氨基转移酶和α 羟丁酸脱氢酶水平 ,比较治疗前后肌酶水平的变化。结果　甲减肌病患者经甲状腺激素替代治疗甲状腺功能正常后 ,肌酶水平显著下降 (P <0 .0 0 1) ,并达正常范围。结论　甲减肌病患者肌酶明显升高 ,并随甲状腺激素替代治疗后代谢恢复正常而恢复正常 ,甲减肌病预后良好     

Myopathy in acute hypothyroidism

Hypothyroid myopathy has so far been reported in long standing cases of hypothyroidism. We describe two adult patients with myopathy associated with acute transient hypothyroidism. Both presented with severe muscle aches and cramps, stiffness and spasms. Muscle enzymes were markedly elevated and electromyography in one patient showed myopathic features. Histological changes were absent in muscle biopsy, probably because of the short duration of metabolic disturbance. The myopathy subsided promptly when the hypothyroid state was reversed.     

全身与大腿MRI对皮肌炎/多发性肌炎的对比研究

目的结合皮肌炎/多发性肌炎(DM/PM)的临床及磁共振特点,突出全身MRI对该病的诊断价值。方法回顾性分析5例DM/PM病例,总结其一般资料、实验室检查、临床检查及影像学表现,同时结合文献进行讨论。结果 5例DM/PM病例,2例DM,3例PM,均因肌痛肌无力伴或不伴皮疹就诊,均有不同程度的肌力减退,且主要以四肢近端肌力减退为主,肌张力均正常,均合并间质性肺炎,MRI检查均提示相应部位的炎症性肌病表现。除1例α-羟丁酸脱氢酶未测、1例谷草转氨酶及肌酸激酶MB同工酶正常外,其余所测6种肌酶水平均升高。结论皮肌炎/多发性肌炎具有一定的MRI特点,可以为临床诊断及鉴别诊断提供帮助。     

High elevations of creatine phosphokinase in hypothyroidism. An isoenzyme analysis

In hypothyroidism, slight elevations of serum creatine phosphokinase (CPK) levels are common. In contrast, we describe six hypothyroid patients with extreme elevations (17- to 160-fold) of CPK levels. Enzyme analysis showed only MM isoenzyme in four cases and MM plus trace MB isoenzyme in two patients. Hypothyroidism should, therefore, be considered when elevated CPK levels, even extreme, are found. Isoenzyme analysis in such a case will show primarily an MM pattern, although trace MB fraction can also be seen. This isoenzyme pattern suggests that the sources of the CPK elevations is skeletal muscle.     

EMG STUDY IN THE DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF LIPID STORAGE MYOPATHY

Clinical, electromyographic and pathological features were studied in 18 patients with lipid storage myopathy （group I ) and 18 patients with polymyositis and dermatomyositis (group Ⅱ ). The results showed a remarhable lower stxmtaneous activity(SA) incidence (14%) in group I than that (55%) in group Ⅱ ;46% and 34% short-duration motor unit potentials(MUAPs) with polyphasic potentials and 74% and 71% short-duration MUAPs without polyphasie potsntials respectively； the percentages of increased polyphasic MUAPs wre same in the Vwo groupa. The reduced or pathologic interfereuce palms accmmted for 61% in the group I and 50% in group Ⅱ. Increased CPK, LDH and HBD were also found in both of them. It is suggested that the lipid storage myopathy may be diagnosed when patients have muscle weakness and myalgia with short-duration and low-amplitude and polyphasic MUAPs without or with occasional spoataneous activitie*, and increased CPK, LDH and HBD.     

Hypothyroidism masquerading as polymyositis

A group of patients is described who presented with proximal muscle weakness and elevated muscle enzymes. They were initially believed to have polymyositis and one of them was even treated as such over a long period of time. The patients were subsequently found to have hypothyroidism and responded well to thyroid hormone replacement.     

Epsilon aminocaproic acid (EACA) myopathy.

Two female patients developed a severe, painful proximal myopathy after taking 18--30 g of epsilon-aminocaproic acid daily for 5 weeks. Marked elevations of serum aminotransferases, creatine kinase and aldolase levels were found and the first patient had electromyographic and muscle biopsy changes of an acute monophasic, necrotising myopathy at the height of the illness. Resolution occurred in both cases on stopping the drug and the second patient had no electromyographic or muscle biopsy abnormalities 3 weeks later. Only 2 recognized cases of the condition have been reported previously but a review of the literature revealed several other possible examples.     

皮肌炎及多发性肌炎伴恶性肿瘤13例临床分析

目的：分析皮肌炎及多发性肌炎伴发恶性肿瘤患者的临床情况。方法：回顾性分析我院2002年至2009年8年间13例皮肌炎及多发性肌炎伴发恶性肿瘤患者,分析其临床表现、实验室辅助检查指标和治疗情况。结果：77例皮肌炎及多发性肌炎患者中16.88%（13/77）伴发恶性肿瘤,伴发的肿瘤主要为鼻咽癌、肺癌、胃癌,其中鼻咽癌占30.76%。伴发肿瘤的相关因素包括炎性肌病的发病年龄〉40岁的男性患者,甲周红斑、GLB升高〉35g/l,而合并肺间质纤维化的炎性肌病患者较少合并恶性肿瘤。结论：皮肌炎及多发性肌炎常伴发恶性肿瘤,所伴发肿瘤的类型广泛,但以鼻咽癌常见。对出现甲周红斑等皮肤血管炎表现年龄大于40岁的的男性皮肌炎及多发性肌炎者尤其在发病1~2年内应警惕伴发恶性肿瘤。     

以呼吸衰竭为首发表现的成人线粒体肌病1例报告并文献复习

目的探讨线粒体肌病并发呼吸衰竭的发病机制和临床特点。方法报告1例以呼吸衰竭为首发表现的成年线粒体肌病患者的临床资料,并复习相关文献。结果患者临床表现为胸闷;血清肌酶谱检查：肌酸激酶（CK）208U／L,乳酸脱氢酶（LDH）546U／L,天冬氨酸氨基转移酶（AST）50U/L;血气分析提示Ⅱ型呼吸衰竭,肺功能存在限制性通气功能障碍,肌电图提示肌源性损害。肌肉病理发现组织中散在典型的不整红边纤维．电镜下见线粒体内存在晶格状包涵体。结论线粒体肌病可以单纯累及呼吸肌．因通气功能障碍而导致呼吸衰竭。成年人可以慢性呼吸衰竭为线粒体肌病的首发表现。